Related Experiment Video
Updated: Jun 25, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Postoperative Pain Outcomes and Satisfaction in Preschool Versus School-Age Children: A Prospective Multicenter
Salah N El-Tallawy1,2, Joseph V Pergolizzi3, Abdullah T Alsubaie4
1Anesthesia and Pain Management, Faculty of Medicine, Minia University and National Cancer Institute, Cairo University, Cairo, EGY.
Insights
Effective pediatric postoperative pain management hinges on modifiable factors, not just age. Strategies like early pain control, regional anesthesia, and preoperative education significantly improve outcomes and patient satisfaction in children.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Outcomes
Background:
- Postoperative pain in children is a significant challenge due to developmental variations in pain perception and reporting.
- Limited evidence exists on age-specific predictors of severe pain and satisfaction when considering perioperative, psychological, and analgesic factors.
- Many pediatric patients experience inadequate pain relief despite advancements in multimodal analgesia.
Purpose of the Study:
- To evaluate postoperative pain trajectories in children undergoing elective surgery.
- To identify predictors of severe pain and factors influencing patient satisfaction.
- To stratify findings by developmental age groups: preschool (3-6 years) and school-age (6-12 years).
Main Methods:
- Prospective, multicenter observational cohort study of 325 children (3-12 years).
- Pain assessed using age-appropriate scales (FLACC for preschool, NRS for school-age) in the first 24 postoperative hours.
- Multivariable logistic and linear regression analyses identified predictors of severe pain and satisfaction.
Main Results:
- Severe pain occurred in 26.5% of patients, with no significant age group difference.
- Predictors of severe pain included early postoperative pain, pain at discharge, preoperative anxiety, and need for additional analgesia.
- Regional anesthesia, pre-incisional local anesthetic infiltration, premedication, and preoperative education were associated with reduced severe pain. High satisfaction was linked to effective pain relief and patient/parent involvement.
Conclusions:
- Postoperative pain outcomes in children are primarily influenced by modifiable perioperative factors, not solely age.
- Early pain control, multimodal analgesia, regional anesthesia, and patient-centered strategies improve pain management and satisfaction.
- Findings support individualized, risk-stratified approaches to pediatric perioperative pain management.
Abstract:
Background Postoperative pain management in children remains a significant challenge due to developmental differences in pain perception, reporting, and communication. However, limited evidence exists regarding age-specific predictors of severe pain and patient satisfaction among preschool and school-age children, particularly when perioperative, psychological, and analgesic-related factors are integrated. Despite advances in multimodal analgesia, a substantial proportion of pediatric patients continue to experience inadequate postoperative pain relief. Objectives To evaluate postoperative pain trajectories, identify predictors of severe pain, and assess factors associated with satisfaction in pediatric patients undergoing elective surgery, with stratification by developmental age groups (preschool versus school-age). Methods This prospective multicenter observational cohort study included 325 children aged three to 12 years undergoing elective surgery under general anesthesia, with or without regional anesthesia (RA). Patients were categorized into preschool (3-6 years, n=175) and school-age (6-12 years, n=150) groups. Pain intensity was assessed at predefined time points during the first 24 postoperative hours using age-appropriate validated scales: the Face, Legs, Activity, Cry, Consolability (FLACC) scale for preschool children and the Numerical Rating Scale (NRS) for school-age children. Severe pain was defined as NRS ≥7/10. Satisfaction with pain management was recorded on a 0-10 scale. Multivariable logistic regression identified independent predictors of severe pain, while linear regression evaluated factors associated with patient satisfaction. Results Pain scores peaked in the early postoperative period and declined significantly over time (P<0.001). Severe pain occurred in 26.5% of patients, with no significant difference between groups (P=0.324). School-age children reported higher pain immediately postoperatively, whereas preschool children exhibited higher pain scores later during recovery. Independent predictors of severe pain included higher early postoperative pain, pain at discharge, preoperative anxiety, and the need for additional analgesia. In contrast, pre-incisional local anesthetic infiltration (LAI), RA, premedication, and preoperative education were associated with lower odds of severe pain (all P<0.05). Satisfaction scores were high (mean 8.1±1.1) and were positively associated with effective pain relief, use of regional techniques, and patient/parent involvement in care. Conversely, persistent severe pain, higher early postoperative pain, and the need for additional analgesia were associated with lower satisfaction. Regression models demonstrated strong predictive performance, with Nagelkerke R² values up to 0.884 and an adjusted R² of 0.434. Conclusion Postoperative pain outcomes in children are predominantly associated with modifiable perioperative factors rather than age alone. Early pain control, multimodal analgesia, RA, and patient-centered strategies, including preoperative education and shared decision-making, are consistently associated with improved pain outcomes and satisfaction. These findings support the development of risk-stratified, individualized approaches to pediatric perioperative pain management.
