Paediatric Anaesthesiology
584
Postoperative pain scores at home after adenotonsillectomy in children between 6 and 12 of age are associated with pre-existing emotional/behavioral problems
Anaesthesia,paediatric, Pain,acute, Model,acute pain service
P. J. Snaterse-Broekhuijse1, E. U. Utens2, M. Poley3, T. Pirotte4, F. Weber5, J. Berghmans6
1Department of Anesthesia, ZNA Middelheim, Queen Paola Children’s Hospital; Department of Anesthesiology; University Hospital - Antwerp (Belgium), 2Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children’s Hospital, University of Amsterdam-POWL/the Bascule - Rotterdam (Netherlands), 3Institute for Medical Technology Assessment, Erasmus University Rotterdam, Department of Pediatric Surgery, Erasmus Medical Center, Sophia Children’s Hospital - Rotterdam (Netherlands), 4Department of Anesthesia, University Clinic St-Luc, Brussels, Belgium - Brussels (Belgium), 5Department of Anesthesia, Erasmus Medical Center Sophia Children’s Hospital - Rotterdam (Netherlands), 6Department of Anesthesia, ZNA Middelheim, Queen Paola Children’s Hospital; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Sophia Children’s Hospital; Department of Anesthesia, Erasmus Medical Center Sophia Children’s Hospital - Antwerp (Belgium)


Background and Goal of the Study
Pain at home after adenotonsillectomy is a major issue and specific child factors like pre-existing emotional/behavioral problems might be associated with higher pain scores [1]. Aims: 1. to assess the prevalence of postoperative pain at home during the first three days and at day 10; 2. to test the influence of emotional/behavioral problems on postoperative pain corrected for the child’s age and parental state anxiety.
Materials and Methods
After IRB approval a prospective cohort study was carried out. Inclusion: eligible were all consecutive children between 6 and 12 years old, ASA 1&2, good Dutch comprehension of the parent, undergoing adenotonsillectomy in a day-care setting. Exclusion: known mental retardation.
Procedure: a standardized anesthesia procedure was performed including: 1. inhalation with sevoflurane; 2. pain management (including Non-Steroidal Anti-Inflammatory Drugs [NSAIDs] and paracetamol). Outcome parameter: postoperative pain at home was assessed using the Parents’ Postoperative Pain Measure (PPPM) during the first 3 days and at day 10.
Psychological assessment tools: 1. child: emotional/behavior problems of the child during the past 6 months were assessed using the Child Behavior Checklist (CBCL) and rated by the accompanying parent. A CBCL total problem score was obtained; 2. parent: parental state anxiety was measured by Spielberger’s State-Trait Inventory (STAI). Statistics: multivariable regression analysis was carried out, using the sum of the PPPM scores at the first 3 days at home (PPPM1-3days) as the dependent variable.
Results and Discussion
A total of 57 children (mean age in months: 108.8 SD ± 25.7) entered this study and 46 (80%) complete cases were obtained at day 3 postoperative. During the first 3 days at home, 43.5% of children had scores ≥ 6 on PPPM1-3days and at day 10 still 2.7% (37 complete cases). Pre-existing CBCL total problem scores were associated with higher PPPM1-3days scores (standardized regression coefficient: .373; 95%CI [.10-.86]; P=.015), independent of the child’s age and parental state anxiety. Overall the model explained 17.9 % of variance (adjusted R2= .119; P=.042).
Conclusion(s)
Pre-existing CBCL emotional/behavioral problems might contribute to higher postoperative pain scores after adenotonsillectomy at home and could be helpful in identifying vulnerable children.
Reference
1.         1. Dorkham M. et al. Paediatr Anaesth, 2014. 24(3): p. 239-48.


04 / Postoperative pain scores at home after adenotonsillectomy in children between 6 and 12 of age are associated with pre-existing emotional/behavioral problems