Anaesthetists want tonsillectomy study to take pain out of surgery

More than 50,000 Australian kids and young adults have their tonsils out every year, with a team of pediatric anaesthetists determined to help them recover better and faster than ever.

It is the most common surgical procedure for children that dates back 2000 years and now a team of Australian pediatric anaesthetists want to help give the humble tonsillectomy a makeover.

Anaesthetist Paul Lee-Archer will lead a large national trial to investigate how best to deliver a speedier recovery with fewer complications for the more than 50,000 children and young adults who have their tonsils out in Australia each year.

He says the goal is to deliver a better understanding of why some young patients can take up to three weeks to recover and to identify before surgery those likely to have recovery problems.

On the road to recovery: Harry Knight, 3, had his tonsils out last month. Picture: Mark Stewart

“There are many different surgical and anaesthetic techniques, however we still don’t know the best combination of these to ensure the best recovery for children and their families,” Prof Lee-Archer said.

“What is needed is a large-scale study and an innovative trial design involving anaesthetists and ear, nose and throat surgeons that can provide definitive answers to improve the recovery process for children undergoing tonsillectomies.”

Prof Lee-Archer said the trial would be unique as it would be ongoing and flexible.

“As new treatments or new surgical techniques become available we can add them into the trial making it adaptable to reflect our actual everyday practice,” he said.

“At its core the goal is to help children recover better and faster.

Anaesthetist Prof Paul Lee-Archer will help lead the national trial to investigate how to improve tonsillectomies. Picture: Supplied

“It is important because we do a lot of tonsillectomies in Australia so while it is common, it is also one of the most painful procedures and can have a lengthy recovery. That means there’s time off crèche or school and parents have to take time off work.”

Prof Lee-Archer said there was also a reasonably high rate of representation to emergency departments or GPs for complications after surgery such as pain management or bleeding that impacts families.

The role of the tonsils, which are like lymph nodes in the back of the mouth and top of the throat, is to help filter bacteria and other germs to prevent infection in the body.

Prof Lee-Archer said they are removed mainly for recurrent tonsillitis, throat infections and obstructive sleep apnoea.

Three-year-old Harry Knight from Ballarat had all three.

Harry, 3, had his tonsils out last month after suffering many colds, ear infections and days off creche. Picture: Mark Stewart

He had his tonsils out a month ago in a day procedure and while on the road to recovery now, his parents Chris and Stacey say it has been slow and painful.

Both have used most of their sick leave for the past 18 months to care for Harry after he developed many ear and throat infections because of his inflamed tonsils that also caused some sleep apnoea.

“Five hours after he had his first visit to daycare he came down with hand, foot and mouth disease,” Mr Knight said.

“Every year since he has used all his allowable absent days because of throat infections.”

Mr Knight said while Harry was initially waking every two hours when he first came home following his tonsillectomy, he was improving every day and very excited to meet his new sibling, due in July.

Prof Lee-Archer said most tonsillectomies in Australia are carried out on children aged between four and eight, although some adults do have the surgery.

He will present details of the trial in an address to the annual scientific meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) on Monday in Brisbane.