Post-tonsillectomy Pain Management Research Articles

Pre-emptive Nebulized Ketamine Versus Lidocaine for Post-tonsillectomy Pain Management in Children: A Comparative Study

Pre-emptive Nebulized Ketamine Versus Lidocaine for Post-tonsillectomy Pain Management in Children: A Comparative Study

Glossopharyngeal Nerve Block for the Management of Post-Tonsillectomy Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Glossopharyngeal Nerve Block for the Management of Post-Tonsillectomy Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Comparative Analysis of Nebulized Versus Intravenous Fentanyl for Pain Control After Tonsillectomy: A Double-Blind, Randomized, Controlled Trial.

Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients. In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria. From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group (P = .009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups. Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients.

Comparative efficacy of topical lidocaine, tetracaine, and articaine for post-tonsillectomy pain management in children: a prospective, placebo-controlled study

Background The most important problem in tonsillectomy is pain in the early postoperative period. Objective We purposed to compare the effects of lidocaine, tetracaine, and articaine application to the peritonsillar bed on post-tonsillectomy pain in children. Methods The prospective, placebo-controlled study included 80 patients, ages 3–14, who were scheduled for elective tonsillectomy. Patients were randomly divided into four groups. Group 1 received 0.9% NaCl; group 2 received 2% lidocaine; group 3 received 2% tetracaine; and group 4 received 4% articaine to the tonsillary bed for 5 min just after the operation. All patients were evaluated in terms of pain and pain-related adverse events in the postoperative 24 h. Results All groups that used local anesthetics had significantly lower pain levels than the control group in the first eight hours (p < .001). Furthermore, the articaine group had a lower pain score than the tetracaine group at the eighth hour (p < .05). The articaine group had a lower pain score at the 16th hour than both the control and tetracaine groups (p < .05). There was no significant difference between the groups at the 24th hour (p > .05). Conclusion and significance We recommend the immediate application of topical articaine to the tonsillar bed following the procedure to enhance postoperative pain management.

Posttonsillectomy Pain Relief and Wound Healing by Applying Bismuth Iodoform Paraffin Paste (BIPP) to Dissected Tonsillar Beds.

Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma. Objective To evaluate the efficacy of applying bismuth iodine paraffin paste (BIPP) to the dissected fossa as an adjuvant therapy for a better outcome in terms of posttonsillectomy pain management and due to its wound healing properties. Methods The present is a prospective randomized control pilot study with 44 patients aged > 7 years who underwent tonsillectomy. The patients were divided into two groups: the control group and the group that had BIPP applied to the dissected tonsillar fossa. The visual analogue scale score and the post-onsillectomy percentage of tonsillar fossa epithelization were recorded and evaluated. Results Both subjectively and objectively, there a was statistically significant pain-relieving effect in the BIPP group within the first 5 postoperative days ( p < 0.05). From postoperative day 3 onward, the dissected area of the tonsillar fossa healed significantly faster in the BIPP group compared with the control group, and it became stable on day 14. Conclusion The topical application of BIPP showed a better pain-relieving effect, it was safe, and hastened wound healing after tonsillectomy.

Ropivacaine 0.25% versus bupivacaine 0.25% in immediate post tonsillectomy pain management: a randomised control trial

Background: Tonsillectomy is one of the most common surgeries performed by an otolaryngologist, with post operative pain during the initial 24 hours being one of the most common challenging concerns. This makes it a need to find a suitable mode for managing the post operative pain imperative. This study aims to: assess the post operative pain control with ropivacaine 0.25% and bupivacaine 0.25% and to assess which among these two drugs are better in controlling the post operative pain and safer. Methods: The 70 patients were selected, randomized, double blinded into group 1 and group 2 and given intraoperative infiltration of either 0.25% ropivacaine or 0.25% ropivacaine respectively into the tonsillar bed after tonsillectomy. The surgeries were done by the same surgeon by cold steel method of tonsillectomy. Post operative pain was evaluated using VAS (visual analogue scale) at regular intervals. Other parameters like hemodynamic status, surgical duration, any adverse reactions to the medications are also recorded. Results: There was a statistically significant difference seen in the post operative pain scores between the two groups at all time intervals, with group 1 having a lower score compared to group 2. Conclusions: Intraoperative infiltration of local anesthetics into the tonsillar bed was effective in controlling the post operative pain, with ropivacaine suitable anesthetic agent as compared to bupivacaine due to its higher efficacy and safety.

PAIN MANAGEMENT: EFFECT OF CHEWING EXERCISES IN POST TONSILLECTOMY PATIENTS

Objective: To assess the effect of chewing in addition to pharmacological management of post-tonsillectomy pain and return to the normal diet. Methodology: To determine the impact of chewing gum on post-operative pain, a 12-month comparative cross-sectional study was carried out on 87 post-tonsillectomy patients at the Pakistan Institute of Medical Scienc­es (PIMS) Islamabad. Two groups of patients having elective tonsillectomy were created: Group A (chewing gum) and Group B. (routine care). Following surgery, patients were monitored to assess postoperative pain using a Visual Analogue Scale (VAS) from day 1 to day 7 and resume their regular diet. Results: Out of 87 patients, 49 (56.3%) belonged to group A, and 38 (43.7%) belonged to group B. Mean age of the participants was 23.8±5.2 years. The total number of male and female participants was 56 (64.4%) and 31 (35.6%) respectively. There was significantly lesser pain experienced by patients in group A as compared to group B from day 2 through day 5 (p&lt;0.001), whereas there were no statistically significant differences observed between the two groups on the 1st,6th and 7th post-operative days in terms of post-op pain (p=0.589, 0.516, 0.376). In terms of resuming a normal diet, there was no statistically significant difference between the two groups. (p= 0.456). Conclusion: Postoperative use of chewing exercises significantly decreases pain in the immediate post-ton­sillectomy period and is recommended for use as a non-pharmacological adjunct for post-tonsillectomy pain management.

Comparison of celecoxib and acetaminophen for pain relief in pediatric day case tonsillectomy: A randomized double-blind study.

ObjectivePost‐tonsillectomy pain is a common morbidity in children. The aim of this study was to compare the efficacy of celecoxib with acetaminophen on pain relief in pediatric day‐case tonsillectomy.MethodsWe compared the analgesic effect of celecoxib (99 patients) with acetaminophen (100 patients) for the management of post‐tonsillectomy pain. Post‐tonsillectomy pain score was evaluated three times a day for 7 days. In addition, the incidence of post‐tonsillectomy bleeding and the rate of patients who returned to regular diet were evaluated.ResultsIn the first day, we observed lower mean pain score in the celecoxib group, than the acetaminophen group (P = 0.013). The overall pain score in other days was not significantly different between the two groups. In the celecoxib group, more patients resumed regular amount of oral intake within the first 3 days. Also, the rate of post‐tonsillectomy bleeding in the two groups was not statistically different.ConclusionWe recommend celecoxib as a more suitable choice than acetaminophen for post‐tonsillectomy pain management in the first day and resuming regular diet within 3 days.Level of Evidence: 1b.

Nonpharmacological Management of Posttonsillectomy Pain

Tonsillectomy is a frequently performed surgical procedure by otolaryngologists. Patients' complaints of posttonsillectomy pain are unavoidable. Pain is a significant obstacle for rehabilitation of the patients following tonsillectomy and it influences the duration of the hospital stay and ability to revive for normal activity. The pain following tonsillectomy often affects oral intake, ability to return to their daily world, and discharge from the hospital. The relief of posttonsillectomy pain remains challenging and even controversial. Pain is common and intense in the posttonsillectomy period. Posttonsillectomy is one of the most common unpleasant side effects of tonsillectomy. There are several techniques and treatment methods available to get relief from posttonsillectomy pain. Although this area has received little scientific attention until now, the desire for alternatives to drug-based treatment for posttonsillectomy pain has continued to develop in recent years. Currently, pain following the posttonsillectomy period continues to be a highly debated issue and an area of active research. Throat pain in the posttonsillectomy period can result in significant morbidity among patients. There are different pharmacologic agents available; each one has its risk profile and side effects when used for controlling posttonsillectomy pain. However, here this reviews article discusses important nonpharmacological agents for the management of posttonsillectomy pain. This article reviews the epidemiology, pathophysiology, and details of nonpharmacological agents used for controlling posttonsillectomy pain.

Current treatment of post-tonsillectomy pain: a review

&lt;p class="abstract"&gt;Tonsillectomy is one of the most common surgical procedures performed by an otorhinolaryngologist. This surgery is done more in the pediatric age group. Although tonsillectomy is safe and effective surgery, it is usually associated with significant post-operative pain. Analgesics used for post-tonsillectomy pain is often inadequate. Severe throat pain following tonsillectomy has been documented for decades. Patients or parents/caretakers often worry about such severe pain in the home. The pain following tonsillectomy is usually intense and long-lasting. The severe post-tonsillectomy pain often overstrains the patient, family, and hospital staff. Regular changes in the analgesic armamentarium, particularly in pediatric patients are making the treatment of post-tonsillectomy pain more challenging. Pain following the tonsillectomy period continues to be a highly debated issue and an area of active research. Throat pain in the post-tonsillectomy period can result in significant morbidity among patients. There are different analgesics available; each one has its risk profile and side effects when used for controlling post-tonsillectomy pain. This review article discusses on recent management of post-tonsillectomy pain. This article reviews the epidemiology, pathophysiology, impact of post-tonsillectomy pain, and details of medications used for controlling post-tonsillectomy pain.&lt;/p&gt;

Post-tonsillectomy pain management in pediatric patients-a review

Tonsillectomy is a common surgical procedure performed in the pediatric age group. Although tonsillectomy is a safe surgery, it is associated with significant post-operative pain. Analgesia after tonsillectomy is often inadequate. Severe post-tonsillectomy throat pain has been described for more than a decade. Parents often worry for handling the pain of their children in home. Post-tonsillectomy pain is often considered as a long lasting and intense in nature. Post-tonsillectomy pain in children is an important problem which overstrains the patient, family and hospital staff. Post-tonsillectomy pain in children is an important problem which overstrains the patient, family and hospital staff. Regulatory alteration in the analgesic armamentarium, particularly in pediatric patients are making the treatment of post-tonsillectomy pain more difficult. Post-tonsillectomy pain in pediatric patients continues to be highly debated clinical issue and also an area of active research. Post-tonsillectomy pain can result in significant morbidity among pediatric patients. There are several analgesics available; each one has its own risk profile and unique side effects when used in pediatric age group in post-tonsillectomy period. This review article provides an update on recent management of post-tonsillectomy pain in pediatric patients. This article reviews the epidemiology, pathophysiology, impact of post-tonsillectomy pain in children and details of medications used for controlling post-tonsillectomy pain.

Effect on Post-Tonsillectomy Pain after Peri-Tonsillar Infiltration of 0.75% Ropivacaine: A Prospective Study

Background and objectives: To study the efficacy of peri-tonsillar infiltration of 0.75%ropivacaine with adrenaline in the management of post-tonsillectomy pain. Materials and methods: This prospective study was conducted in the department of Otorhinolaryngology and Head and Neck Surgery, Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Mandya district. The study period was from November 2017 to July 2019. A sample size of 30 patients which satisfied the inclusion criteria was included in the study. Ropivacaine (0.75%) with Adrenaline (1:200000) was locally infiltrated on the right side (R-side) in the peri-tonsillar region before the surgery and in the tonsillar fossa after the surgery. The left side was considered as the control side. Patients were followed up on 1st and 7th post-operative days for the measurement of post-operative pain. For the assessment of post-operative pain, Visual Analogue Scale was used (VAS). Results: 17(56.7%) females and 13(43.3%) males participated in the study. Majority of the cases belonged to &lt;10 years of age group. On 1st post-operative day, pain on the right side was significantly lower compared to the left side (p value &lt;0.0001), however the reduction of pain scores on right side compared with that of the left side was not significant (p value=0.536) on the 7th post-operative day. Interpretation and conclusion: The peri-tonsillar infiltration of ropivacaine(0.75%) with adrenaline (1:200000) is effective and significant in reducing post-operative pain on the 1st post-operative day, but not so significant on the 7th post-operative day .Hence we recommend the use of peri-tonsillar infiltration of ropivacaine (0.75%) with adrenaline in view of better management of post-operative pain.

Assessment of the Management of Post-Tonsillectomy Pain at the ENT-CFS Department of Ignace Deen National Hospital

Introduction: Tonsillectomy is described as one of the oldest surgical procedures according to the authors of the surgical treatise (Aulus Amida and Paul of Aegina in the 6th and 7th centuries) found in the Vatican library. The contraindication of codeine in children has changed the management of post tonsillectomy pain. The aim of this study was to assess the management of post tonsillectomy pain in our developing country context. Methods: This was a prospective, analytical study lasting 6 months (September 2019-February 2020), carried out in the ENT/CFS department of the Ignace Deen National Hospital. We included in this study all patients who underwent a tonsillectomy in the department during the study period and who agreed to participate in the survey. Results: 34 patients were included in our study, i.e. a frequency of 25% of surgical interventions. The mean age of our patients was 18.06 ± 12 years with extremes of 03 years and 45 years. Recurrent hypertrophic tonsillitis with sleep disturbances was the most frequent indication for surgery in our study, at 47.06% (n = 16). We performed an isolated tonsillectomy in 52.9% (n = 18) of cases. Analgesia was multimodal using the WHO Step I and II analgesics in 44.1% (n = 15) and 55.9% (n = 19), respectively. Pain control was satisfactory in all patients. Conclusion: The evaluation of post tonsillectomy pain is essential for optimal management. In this indication, multimodal analgesia, involving several levels I and II analgesics, provided satisfactory pain control.

Effect of pre-incisional infiltration of 0.5% ropivacaine versus placebo in post-operative pain relief among patients undergoing tonsillectomy under general anaesthesia: a comparative study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pain is the most common complaint in the immediate post-tonsillectomy period. Inadequate post-tonsillectomy pain management has many drawbacks. Ropivacaine is a new long acting local anaesthetic, structurally closely related to bupivacaine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;It was a prospective double blinded randomized control trial on a total of 50 patients who were posted for tonsillectomy. Randomization of each patient was done into two groups one of which had received 4 ml of 0.5% ropivacaine hydrochloride solution and other 4 ml normal saline. Data entry and analysis was done with (SPSS IBM) version 21.0. Both univariate and bivariate analysis done. Proportions were calculated for qualitative variables and mean with standard deviation was done for quantitative variables. Required tests of significance such as Chi square test and independent test were applied. Significance of p value is taken as p&amp;lt;0.05. Postoperative pain, first post op oral intake, duration of post-operative hospital stay, and postoperative haemorrhage was assessed. The intensity of postoperative pain was assessed on behavioural observational pain Scale and Wong baker faces pain rating scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Pre-incisional infiltration of 0.5% Ropivacaine was an effective method to reduce post-operative pain in patients undergoing tonsillectomy under GA. Effect of Ropivacaine was statistically significant (p&amp;lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We recommend the use of 0.5% ropivacaine pre-incisional infiltration in patients undergoing tonsillectomy.&lt;/p&gt;

Comparative Study Between Bupivacaine Infiltration, Topical Lidocaine and Intravenous Paracetamol in Management of Post-Tonsillectomy Pain in Children

Background: Tonsillectomy operation is a one of the most commonly performed procedures in pediatric population. Post-operative pain control in those children is very important. Objective: To compare the efficacy of bupivacaine infiltration in gloss-tonsillar sulcus, applying a gauze soaked in lidocaine (10%) in tonsillar bed and intravenous injection of paracetamol in management of post-tonsillectomy pain in children. Patients and Methods: Sixty kids of both sexes were included in this clinical randomized study, aged from 5to 12 years undergoing tonsillectomy at Al-Azhar university hospitals between January 2019 and December 2019. They were randomly allocated into three equal groups: Group (A) underwent pre-operative single-point superficial infiltration of a dose of 1 mg/kg bupivacaine (0.5%) in glosso-tonsillar sulcus, Group (B) underwent post-operative application of a soaked piece of gauze in lidocaine (10%) in the tonsillar bed, and Group (C) underwent preoperative intravenous infusion of 10mg/ml paracetamol solution. They were followed up to assess the effectiveness and safety of which medication in pain management post tonsillectomy. Results: There was no statistically significant difference between pain scores in the three groups after 30 minutes, 2 and 6 hours. There was a statistically significant difference between pain scores in the three groups after 12, 18 and 24 hours respectively. Pair-wise comparisons between the groups revealed that Group B showed the statistically significantly highest mean pain score. There was no statistically significant difference between Group A and Group C; both showed the statistically significantly lowest mean pain scores. Conclusion: The glossopharyngeal nerve block with plain bupivacaine (0.5%) in glooso-tonsillar sulcus is a safe, effective &easily applicable method for post-tonsillectomy pain management and has a significant prolonged duration of analgesia in comparison to topical lidocaine and Intravenous paracetamol. However, paracetamol injection was more effective than lidocaine infiltration.

Peritonsillar Ropivacaine Infiltration in Paediatric Tonsillectomy: A Randomised Control Trial.

Introduction:Various efforts have been made to reduce post tonsillectomy pain in children. The present study was undertaken to evaluate the efficacy and safety of Ropivacaine in post-operative pain management in these children.Materials and Methods:This study is a Randomized control study on 140 patients between 4 - 12 years of age, in whom tonsillectomy was performed in a tertiary care centre between January 2017 to November 2018 using standard dissection and snare surgical technique. Postoperatively, patients were randomized into 2 groups of 70 patients each, receiving tonsillar fossa infiltration with 0.2% Ropivacaine or 0.9% normal saline respectively. Patients were assessed as per Wong Baker’s Faces Scoring System at 2 hours, 4 hours, 8 hours, 18 hours, 24 hours, and 48 hours postoperatively. All the results were analyzed by SPSS software. Chi- square test and Mann-Whitney test were used for assessment of level of significance, with P- value of less than 0.05 taken as significant. Results:Both the groups were comparable with respect to age and sex. At 48 hours, in study group, maximum number of patients 35 (50%) had Wong Baker score 0, while in control group, maximum number of patients 52 (74.3%) had Wong Baker score 4 (P< 0.01). The difference in the mean Deglutition time between both groups was significant (P< 0.01).Conclusion:Ropivacaine infiltration is a effective modality for post-tonsillectomy pain management in children, with minimal side-effects.

#10-Year Challenge: Local anaesthetic for post-tonsillectomy pain: Update meta-analysis.

Adequate management of post-tonsillectomy pain is an important consideration in postoperative management after tonsillectomy. A 2008 meta-analysis showed that the use of local anaesthetic either by infiltration or topical application reduced postoperative pain. To review the current evidence for the use of local anaesthetic as a means of reducing post-tonsillectomy pain and compare current evidence to the previous meta-analysis 10years ago. Systematic literature searches of MEDLINE [*"ANESTHETICS, LOCAL"/ AND *TONSILLECTOMY/], EMBASE [*"LOCAL ANESTHETIC AGENT"/ AND *TONSILLECTOMY/] and PubMed [(Tonsillectomy).ti,ab AND (Local Anaesthetic).ti,ab OR (Local Anesthetic).ti,ab]. A meta-analysis of randomised control trials assessing the use of local anaesthetic agents for post-tonsillectomy pain. Twenty-three studies were included in the meta-analysis. Overall, local anaesthetic, applied topically or infiltrated, significantly reduces pain scores compared with controls at 4-6hours [-0.65 (95% CI: -0.77; -0.53)]; 24hours [-0.50 (95% CI: -0.66, -0.35)]; and 5-7days [-0.78 (95% CI: -0.90, -0.65)] (standardised mean differences). Current studies suggest that use of peri-operative local anaesthetic during tonsillectomy does improve postoperative pain outcomes. The limitations of the analysis are as follows: all studies are small, and a multi-centred larger trial is recommended to guarantee statistical reliability. There was no description of significant adverse side effects from local anaesthetic use.

Adult post-tonsillectomy pain management: Opioid versus non-opioid drug comparisons

Objective: The primary purpose of this retrospective study was to determine if a non-steroidal anti-inflammatory drug (diclofenac sodium) plus acetaminophen was as effective as alternative opioid drug regimens, +/- ibuprofen and acetaminophen, for pain management in adults following tonsillectomy. Study design: Retrospective study. Setting: 4 hospitals in Michigan associated with the Detroit Medical Center. Subjects and methods: Medical records of adult tonsillectomy patients (age 18 to 50 Years) were reviewed. The incidences of unscheduled post-operative visits to either the ER or ENT clinic for uncontrolled throat pain and/or postoperative bleeding complications were reviewed.

Comparative study between the effect of Diclofenac and Ketorolac in post-tonsillectomy pain management

Introduction: Tonsillectomy is one of the most common surgical procedures performed in children. It is associated with significant pain Ketorolac and Diclofenac are the commonly used NSAIDS for post-tonsillectomy pain; however, they may cause bleeding. Objective: To compare between the effect of diclofenac sodium and ketorolac in post-tonsillectomy pain management and bleeding. Materials and methods: 100 children aged 6-12 years were divided into two groups; Diclofenac group (n=50 patients who received diclofenac sodium analgesia) and Ketorolac group (n= 50 patients who received ketorolac tromethamine analgesia) .Intra-operative and postoperative blood loss was assessed using the following scale for bleeding assessment (0 = no bleeding, 1 = bleeding as usual, 2 = bleeding more than usual, 3 = profuse, 4 = excessive, and lastly 5 = excessive and continuous), while postoperative pain was assessed using the verbal rating scale, the total consumption of additional analgesics used in each group and the time needed to restore normal dietary habits Results: There were no statistical differences between the two groups regarding intraoperative and postoperative bleeding. On the other hand, there was no statistical difference between the two groups regarding postoperative pain management. Forty-eight and forty-six patients returned to their normal dietary habits in the first day post-operative in diclofenac group and ketorolac group respectively. Conclusions: Both ketorolac and diclofenac administered intraoperatively before the start of surgery and continued postoperatively, both drugs effectively and equally controlled post-tonsillectomy pain with no serious adverse effects.

Nasal Sprays Containing Mometasone Furoate For Relief of Post-Adenotonsillectomy Pain In Children: A Prospective Controlled Study

Objectives:Adenotonsillectomy is one of most common surgeries performed in childhood. Post-operative pain associated particularly with tonsillectomy is still a problem for many physicians. Despite advances in surgical techniques, analgesics, or anti-inflammatory drugs, no unique strategy for post-tonsillectomy pain management has been suggested. The aim of this study is to investigate the analgesic effect of steroid containing nasal spray applied to tonsillar region after tonsillectomy.Methods:Eighty-two patients were assigned into two groups as study and control. In study group, nasal spray containing steroid was applied to each tonsillar region after surgery for 5 days. Post-operative pain of all patients was assessed using a visual analog scale and results were compared.Results:Pain decreased gradually over time in both the study and control groups. Although the pain scores from 4 h post-surgery to post-operative day 5 were not found to significantly decrease in children that used nasal spray containing steroid, these patients developed less pain on post-operative day 5,with statistical significance (p<0.05).Conclusion:Post-tonsillectomy pain was reported to increase around post-operative day 5, which coincides with the time of intense wound inflammation. Therefore, significant pain reduction on post-operative day 5 observed in children that used nasal spray with steroid may have clinical importance for overcoming this problem.