DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20214676

Pediatric otolaryngology: influence of ambulatorial surgical procedures on postoperative pain

Francisco Alves de Sousa, Maria Jorge Casanova, Ana Nóbrega Pinto, Miguel Bebiano Coutinho, Cecília Almeida e Sousa

Abstract


Background: In Pediatric Otolaryngology surgery associating procedures is a common finding. Each surgical act elicits different degrees of pain, with implications on recovery. The aim of this work was to evaluate the severity of children's pain after outpatient surgery, considering combinations of common Otolaryngologic procedures.

Methods: Data from children submitted to surgery in the Pediatric ambulatory Unit of Centro Hospitalar Universitário do Porto was reviewed. Children with history of previous interventions or any associated comorbidity were excluded. Postoperative pain at hospital discharge using the Universal Pain assessment tool (0-10) was assessed and compared concerning the various procedures.

Results: A total of 954 operated children were included. Adenoidectomy was performed in 783 patients (82.1%), tonsillectomy in 714 (74.8%), myringotomy in 432 (45.3%) and radiofrequency inferior turbinoplasty in 98 (10.3%). Patients undergoing tonsillectomy showed significantly higher pain scores (1.48±1.02 in tonsillectomy versus 0.89±0.75 in no tonsillectomy, p=0.001). Importantly, adenoid curettage, radiofrequency inferior turbinoplasty and myringotomy did not associate with increased post-operative pain (p>0.05). Number of procedures within the same intervention and surgical indication (recurrent infections, obstructive sleep disordered breathing and otitis media with effusion) did not influence post-operative pain scores (p>0.05).

Conclusions: Performing total tonsillectomy was the most important influencer of post-operative pain in Pediatric ambulatory surgery in this cohort. Performing concomitant adenoidectomy, turbinoplasty or miringotomy do not seem to influence post-operative pain significantly. A higher number of procedures within the same intervention does not associate directly with postoperative pain scores.


Keywords


Paediatric otolaryngology, Children, Surgery, Post operative pain, Tonsillectomy

Full Text:

PDF

References


Verbeeck F, Hens G, Willem L. Postoperative recovery in children after outpatient ENT surgery. B-ENT. 2016;12(3):165-73.

Brasher C, Gafsous B, Dugue S. Postoperative pain management in children and infants: an update. Paediatr Drugs. 2014;16(2):129-40.

Wiggins SA, Foster RL. Pain after tonsillectomy and adenoidectomy: “ouch it did hurt bad”. Pain Manag Nurs Off J Am Soc Pain Manag Nurses. 2007;8(4):156-65.

Muller RG, Thimmappa V, Sheyn A. Post-Operative pain control following Pediatric Otolaryngology Surgery. Madridge J Otorhinolaryngol. 2018;3(1):37-40.

Mitchell RB, Archer SM, Ishman SL. Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary. Otolaryngol neck Surg Off J Am Acad Otolaryngol Neck Surg. 2019;160(2):187-205.

Rodríguez MC, Villamor P, Castillo T. Assessment and management of pain in pediatric otolaryngology. Int J Pediatr Otorhinolaryngol. 2016;90:138-49.

Wilson CA, Sommerfield D, Drake-Brockman TFE, von Bieberstein L, Ramgolam A, von Ungern-Sternberg BS. Pain after discharge following head and neck surgery in children. Paediatr Anaesth. 2016;26(10):992-1001.

Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv Clin Exp Med Off organ Wroclaw Med Univ. 2020;29(3):365-74.

Adler AC, Mehta DK, Messner AH, Salemi JL, Chandrakantan A. Parental assessment of pain control following pediatric adenotonsillectomy: Do opioids make a difference? Int J Pediatr Otorhinolaryngol. 2020;134:110045.

Tuomilehto H, Kokki H, Ahonen R, Nuutinen J. Postoperative Behavioral Changes in Children After Adenoidectomy. Arch Otolaryngol Neck Surg. 2002;128(10):1159-64.

Guntinas-Lichius O, Volk GF, Geissler K, Komann M, Meissner W. Pain after pediatric otorhinolaryngologic surgery: a prospective multi-center trial. Eur Arch oto-rhino-laryngology Off J Eur Fed Oto-Rhino-Laryngological Soc Affil with Ger Soc Oto-Rhino-Laryngology - Head Neck Surg. 2014;271(7):2049-60.

Vons KMJ, Bijker JB, Verwijs EW, Majoor MHJM, de Graaff JC. Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children. Paediatr Anaesth. 2014;24(5):476-82.

Schnelle A, Volk GF, Finkensieper M, Meissner W, Guntinas-Lichius O. Postoperative pain assessment after pediatric otolaryngologic surgery. Pain Med. 2013;14(11):1786-96.