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

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Abstract

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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Acknowledgments

We thank all the departments and clinics that were involved in QUIPSI data collection and treatment of the children: Asklepios Klinik Sankt Augustin; Behandlungszentrum Vogtareuth; Charité University Hospital Berlin; Dietrich-Bonhoeffer-Klinikum Neubrandenburg; Jena University Hospital; Klinikum Traunstein; Krankenhaus St.-Joseph-Stift Bremen; St.-Vincenz-Hospital Coesfeld (all in Germany); Krankenhaus St. Josef Braunau (Austria); and Kantonsspital Luzern (Switzerland).

Conflict of interest

The authors indicate that they have no conflict of interest. The authors have no financial interest to declare in relation to the content of this article.

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Authors and Affiliations

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

    Orlando Guntinas-Lichius, Gerd Fabian Volk & Katharina Geißler

  2. Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany

    Marcus Komann & Winfried Meissner

Authors
  1. Orlando Guntinas-Lichius
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  2. Gerd Fabian Volk
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  3. Katharina Geißler
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  4. Marcus Komann
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  5. Winfried Meissner
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Corresponding author

Correspondence to Orlando Guntinas-Lichius.

Electronic supplementary material

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405_2014_2914_MOESM1_ESM.pdf

Supplementary material 1 (PDF 30 kb) Suppl. Fig. 1. Histogram of the age distribution of the children who did not understand all QUIPSI questions (green) and of the children who understood all questions (blue)

Supplementary material 2 (JPEG 28 kb)

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Guntinas-Lichius, O., Volk, G.F., Geißler, K. et al. Pain after pediatric otorhinolaryngologic surgery: a prospective multi-center trial. Eur Arch Otorhinolaryngol 271, 2049–2060 (2014). https://doi.org/10.1007/s00405-014-2914-9

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  • DOI: https://doi.org/10.1007/s00405-014-2914-9

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