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Propofol Versus Sevoflurane Anesthesia for Acute Postoperative Pain Management in Pediatric Adenotonsillectomy: A
Zhi-Peng Zhong1, Yu Gao1, Cheng Fan1
1Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
Propofol and sevoflurane anesthesia show similar effectiveness for managing acute pain after pediatric adenotonsillectomy. Postoperative pain intensity and incidence were comparable between the two anesthetic agents within the first 24 hours.
Area of Science:
- Anesthesiology and Pain Management
- Pediatric Surgery
- Clinical Trials
Background:
- Post-adenotonsillectomy pain in children is common, severe, and often poorly managed.
- The comparative efficacy of propofol versus sevoflurane for acute pain control following this procedure is not well-established.
Purpose of the Study:
- To evaluate the postoperative analgesic effectiveness of propofol compared to sevoflurane anesthesia in pediatric patients undergoing adenotonsillectomy.
- To determine if there are significant differences in acute pain management between the two anesthetic agents.
Main Methods:
- A single-blind, randomized controlled trial involving 144 children aged 2-7 years.
- Patients were randomized to receive either propofol or sevoflurane anesthesia.
- Primary outcome: proportion of patients with acute pain (FLACC scale > 3) within 24 hours; Secondary outcomes: pain scores (PPPM, NRS) and adverse events.
Main Results:
- No significant difference in the incidence of acute pain (FLACC > 3) within 24 hours between propofol and sevoflurane groups (42.3% vs. 47.9%).
- The propofol group showed slightly higher pain scores on postoperative days 2-3, but these differences were below clinically important thresholds.
Conclusions:
- Propofol and sevoflurane anesthesia provide comparable clinical efficacy for managing acute postoperative pain in children after adenotonsillectomy.
- Neither anesthetic agent demonstrated superior pain control within the first 24 hours or over a two-week follow-up period.
Background:
Pain following pediatric adenotonsillectomy is prevalent, frequently severe, and often inadequately managed. The effectiveness of propofol or sevoflurane anesthesia in acute postoperative pain management is unknown.
Methods:
We conducted a single-blind, randomized controlled trial to examine the postoperative analgesic effectiveness of propofol or sevoflurane anesthesia. 144 children aged 2-7 years were enrolled and randomly assigned to receive either propofol or sevoflurane anesthesia, with 142 completing the study. The primary outcome was the proportion of acute postoperative pain measured by the Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores > 3 within 24 h between the two groups. Secondary outcomes included postoperative pain assessed by the parent's postoperative pain measure (PPPM) scale and numeric rating scale (NRS) on the 1, 2, 3, 7, and 14 postoperative days, as well as perioperative adverse events.
Results:
The incidence of acute pain FLACC > 3 within 24 h showed comparable results between both groups (30 of 71 [42.3%] vs. 34 of 71 [47.9%]; odds ratio [OR] = 0.78, 95% confidence interval [CI]: [0.28, 2.18]; p = 0.500). The propofol group demonstrated higher pain scores on postoperative days 2-3, with between-group median differences (ΔNRS at activity = 1, ΔPPPM = 1) below minimal clinically important difference thresholds (ΔNRS > 1, ΔPPPM > 3).
Conclusions:
The incidence and intensity of acute postoperative pain in the first 24 h after adenotonsillectomy did not differ significantly between pediatric patients who received maintenance anesthesia with propofol or with sevoflurane. The two general anesthesia techniques exhibited comparable clinical efficacy with respect to pain prognosis within 2 weeks.
Trial Registration:
The Chinese Clinical Trial Registry (ChiCTR2300075847, Date of registration: September 3, 2023).
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