Objective tonsil volume as a predictor of postoperative pain in pediatric tonsillectomy: a prospective observational...

Post-tonsillectomy pain is one of the most common morbidities in children, markedly affecting comfort and recovery. Although several factors influencing pain have been explored, the role of tonsil volume remains unclear.

To investigate the relationship between objectively measured tonsil volume and postoperative pain in pediatric tonsillectomy.

This prospective observational study included 150 children aged 4-12 years who underwent bilateral cold-dissection tonsillectomy. Tonsil volume was measured intraoperatively by the water-displacement method. Patients were divided into three groups by total tonsil volume. Postoperative pain was assessed using the Wong-Baker Faces Pain Rating Scale (WB) and the Parents' Postoperative Pain Measure (PPPM) at 1, 6, and 24 h and on postoperative days 3 and 7. Correlations were analyzed with Spearman's test.

Pain scores differed significantly among groups. The largest-volume group showed the highest PPPM scores at all time points (p < 0.001). The strongest correlation occurred between tonsil volume and PPPM scores at 6 h (r = 0.65, p < 0.001), while WB scores on day 7 correlated moderately (r = 0.41, p < 0.001).

Tonsil volume is positively correlated with postoperative pain after pediatric tonsillectomy.

Objective volumetric assessment offers greater predictive value than subjective grading and may guide individualized analgesic and counseling strategies.