'Desire for more analgesic treatment': pain and patient-reported outcome after paediatric tonsillectomy and appendectomy.

Stamer, Ulrike M.; Bernhart, Kyra; Lehmann, Thomas; Setzer, Maria; Stüber, Frank; Komann, Marcus; Meissner, Winfried (2021). 'Desire for more analgesic treatment': pain and patient-reported outcome after paediatric tonsillectomy and appendectomy. British journal of anaesthesia, 126(6), pp. 1182-1191. Elsevier 10.1016/j.bja.2020.12.047

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BACKGROUND

Insufficiently treated pain after paediatric appendectomy and tonsillectomy is frequent. We aimed to identify variables associated with poor patient-reported outcomes.

METHODS

This analysis derives from the European PAIN OUT infant registry providing information on perioperative pharmacological data and patient-reported outcomes 24 h after surgery. Variables associated with the endpoint 'desire for more pain treatment' were evaluated by elastic net regularisation (odds ratio [95% confidence interval]).

RESULTS

Data from children undergoing appendectomy (n=472) and tonsillectomy (n=466) between 2015 and 2019 were analysed. Some 24.8% (appendectomy) and 20.2% (tonsillectomy) wished they had received more pain treatment in the 24 h after surgery. They reported higher composite pain scores (5.2 [4.8-5.5] vs 3.6 [3.5-3.8]), more pain-related interference, and more adverse events than children not desiring more pain treatment, and they received more opioids after surgery (morphine equivalents (81 [60-102] vs 50 [43-56] μg kg-1). Regression analysis revealed that pain-related sleep disturbance (appendectomy odds ratio: 2.8 [1.7-4.6], tonsillectomy 3.7 [2.1-6.5]; P<0.001) and higher pain intensities (1.5-fold increase) increased the probability of desiring more pain treatment. There was an inverse association between the number of different classes of non-opioids administered preventively, and the desire for more analgesics postoperatively. Children not receiving any non-opioid analgesics before the end of a tonsillectomy had a 3.5-fold (2.1-6.5-fold) increase in the probability of desiring more pain treatment, compared with children receiving at least two classes of different non-opioid analgesics.

CONCLUSIONS

Preventive administration of at least two classes of non-opioid analgesics is a simple strategy and may improve patient-reported outcomes.

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