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Pain after pediatric otorhinolaryngologic surgery: a prospective multi-center trial
Orlando Guntinas-Lichius1, Gerd Fabian Volk, Katharina Geissler
1Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany, orlando.guntinas@med.uni-jena.de.
Insights
Pediatric patients undergoing ear, nose, and throat surgery experienced significant pain, with maximal pain scores averaging 4.4. Inconsistent pain management and opioid use were linked to higher pain levels, indicating a need for improved postoperative analgesia.
Area of Science:
- Pediatric Surgery
- Pain Management
- Otorhinolaryngology
Background:
- Postoperative pain in children undergoing otorhinolaryngologic (ENT) surgery is a significant concern.
- Effective pain management is crucial for recovery and patient well-being.
Purpose of the Study:
- To describe the incidence and severity of postoperative pain in children within the first day after ENT surgery.
- To identify factors influencing postoperative pain, including surgical type and analgesic administration.
Main Methods:
- Prospective evaluation of 365 children (≥4 years) using a web-based multi-center registry.
- Pain assessment via faces numeric rating scales (FNRS), functional interference, and side effects.
- Multivariate analysis to identify independent predictors of maximal pain.
Main Results:
- Maximal pain scores averaged 4.4 ± 3.3 (FNRS) within the first postoperative day.
- Pain was most severe after oral surgeries, particularly tonsillectomy and nasal surgery.
- Drowsiness was the most common side effect (55%); 39% reported breathing interference due to pain.
- Maximal pain was associated with non-standardized opioid use in the recovery room and on the ward.
Conclusions:
- Postoperative pain management in pediatric ENT surgery is highly variable.
- Tonsillectomy and nasal surgeries are particularly painful procedures.
- Many children may receive inadequate or ineffective pain relief, necessitating optimized analgesic strategies.
Abstract:
The purpose of this study was to describe postoperative pain within the first day after pediatric otorhinolaryngologic surgery and to identify factors influencing postoperative pain. Using a prospective evaluation and a Web-based multi-center registry, children ≥4 years of age (n = 365) rated their pain using questionnaires of the project Quality Improvement in Postoperative Pain Treatment for Children including faces numeric rating scales (FNRS, 0-10) for the determination of patient's pain on ambulation and his/her maximal and minimal pain within 8 h after day case surgery or at the first postoperative day for inpatient cases. Additionally, functional interference and therapy-related side effects were assessed. Half of the children were 4 or 5 years of age. The predominant types of surgery were adenoidectomy and tonsillectomy ± ear ventilation tubes. Although analgesics were applied preoperatively, intraoperatively, in the recovery room and on ward, maximal pain within the first day after surgery reached 4.4 ± 3.3 (FNRS). Pain was highest after oral surgery, especially after tonsillectomy and nose surgery. 39% of the children reported pain interference with breathing (39%). The most frequent side effect was drowsiness (55%). Multivariate analysis revealed that maximal pain was independently associated with the non-standardized use of opioids in the recovery room, or use of non-opioid or opioids on ward. Analgesia and perioperative pain management in pediatric otorhinolaryngologic surgery seems to be highly variable. Tonsillectomy and nose surgery are very painful. After otorhinolaryngologic surgery many children seem to receive less analgesia than needed or ineffective analgesic drug regimes.
