Pain after pediatric otorhinolaryngologic surgery: a prospective multi-center trial.

Authors:
Orlando Guntinas-Lichius
Orlando Guntinas-Lichius
Jena University Hospital
Germany
Gerd Fabian Volk
Gerd Fabian Volk
Jena University Hospital
Germany
Katharina Geissler
Katharina Geissler
Institute of Medical Immunology; Martin Luther-University Halle-Wittenberg ; Halle
Germany
Marcus Komann
Marcus Komann
Friedrich-Schiller University Hospital
Germany
Winfried Meissner
Winfried Meissner
Friedrich Schiller University
Germany

Eur Arch Otorhinolaryngol 2014 Jul 9;271(7):2049-60. Epub 2014 Feb 9.

Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany,

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.

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Source
http://dx.doi.org/10.1007/s00405-014-2914-9DOI Listing
July 2014
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