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Updated: Jun 14, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Association between children's emotional/behavioral problems before adenotonsillectomy and postoperative pain scores
Johan M Berghmans1,2,3, Marten J Poley4,5, Jan van der Ende2
1Department of Anesthesia, ZNA Middelheim, Queen Paola Children's Hospital, Antwerp, Belgium.
Insights
Children often experience significant pain and sleep issues after adenotonsillectomy. Preoperative internalizing problems and parental information needs are linked to increased pain, suggesting targeted screening can improve care.
Area of Science:
- Pediatric Surgery
- Pain Management
- Child Psychology
Background:
- Adenotonsillectomy in children can lead to severe postoperative pain and sleep disturbances.
- Specific child risk factors for these postoperative issues remain largely uncharacterized.
Purpose of the Study:
- To determine the incidence of postoperative pain and sleep problems in children following adenotonsillectomy.
- To evaluate the impact of internalizing and externalizing behaviors on postoperative pain.
- To assess medication adherence in this pediatric population.
Main Methods:
- A prospective cohort study involved 160 children aged 1.5-5 years undergoing adenotonsillectomy.
- Pain and sleep problems were assessed using validated parental reports during the first 3 days and at 10 days postoperatively.
- Child Behavior Checklist assessed emotional/behavioral problems; regression analysis identified predictors of pain intensity.
Main Results:
- Over 50% of children experienced moderate to severe pain on postoperative days 1 and 2, with 37.1% experiencing sleep disturbances.
- Internalizing problems (β = 0.343, P = 0.001) and parental need for information (β = 0.207, P = 0.011) were independently associated with higher pain scores.
- Regression model explained 22.5% of the variance in home pain scores (R² = 0.225).
Conclusions:
- Post-adenotonsillectomy, children frequently suffer from pain and sleep issues in the initial days.
- Preoperative internalizing behaviors and parental information needs predict increased postoperative pain.
- Screening for these factors can identify at-risk children, enabling tailored perioperative pain management strategies.
Background:
Children undergoing adenotonsillectomy are at risk of severe postoperative pain and sleep problems. Little is known about the specific child risk factors for these problems.
Aims:
The aim of this study was to assess the occurrence of postoperative pain, sleep problems, and medication adherence, and assess the influence of internalizing and externalizing problems on postoperative pain.
Methods:
This prospective cohort study included 160 children, aged 1.5-5 years undergoing day-care adenotonsillectomy. Parents rated their child's pain with the Parents' Postoperative Pain Measure and their child's sleep problems with Vernon's Post Hospital Behavioral Questionnaire during the first 3 days and at day 10 postoperatively. Emotional/behavioral problems (ie, internalizing and externalizing behaviors) during the past 2 months were assessed using the Child Behavior Checklist. Regression analysis was used to assess whether children's pain intensity at home was associated with internalizing/externalizing problems, after controlling for age, preoperative child state anxiety, parental state anxiety, parental need for information, and socioeconomic status.
Results:
Applying a threshold of ≥6 on the Parents' Postoperative Pain Measure, the incidence of moderate to severe pain was 57.6% at day 1, 53.5% at day 2, 35.4% at day 3, and 4.8% at day 10. During the first three postoperative nights, 37.1% of the children woke up. Internalizing problems (β = 0.343; P = 0.001) and parental need for information (β = 0.207; P = 0.011) were independently associated with higher pain scores at home during the first 3 days (R2 = 0.225).
Conclusion:
Following adenotonsillectomy, children often experienced moderate to severe pain and sleep problems during the first 3 days at home. Preoperative internalizing problems and parental need for information were independently associated with increased pain at home. Screening for these problems can help to identify vulnerable children and adapt the perioperative analgesic strategy accordingly (which includes preparation, information, and prescription of pain analgesics).
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