There is a great need for better pain treatment
After appendectomy, a quarter (24.8%) of all children wanted stronger pain treatment in the first 24 hours after surgery. Among children who had tonsillectomy, this was a fifth (20.2%). Analysis of the data showed that this desire was primarily associated with sleep impairment and movement pain. Leading author of the study, prof. Ulrike M. Stamer, explained, “We are dealing with a large number of diseased patients. Appendectomies and tonsillectomies are the most common surgeries in children. Slightly less than a quarter of these cases strongly signal a desire for improvement.”
A comprehensive, multicenter study
This study is based on the international pain register “PAIN OUT Newborn,” which was established in 2015 to monitor the quality of postoperative pain management in children. The study included 472 children with appendectomy and 466 children with tonsillectomy. More pain-related damage and side effects have been reported in children who wanted stronger pain treatment. They also received more opioids postoperatively (an average of 81 versus 50 micrograms per kilogram of body weight).
The surprising result shows the way to optimization
The surprising result came from the analysis of survey data and comparisons with drugs used before and during surgeries. It was found that children who received at least two different classes of non-opial analgesics (NSAIDs, metamizole or paracetamol) as a precaution were significantly less likely to seek stronger pain treatment when examined 24 hours after surgery. Professor Frank Stüber, head of the Department of Anesthesiology at Inselspital (University Hospital of Bern), is optimistic: “We have been able to identify a promising path with these study results. A precaution for at least two different classes of non-opioid analgesics seems to be a way to reduce opioid dose after surgery “.
Inselspital, University Hospital of Bern
Stamer, UM, and others. (2021) ‘Desire for more analgesic treatment’: pain and outcome reported by patients after pediatric tonsillectomy and appendectomy. British Journal of Anesthesia. doi.org/10.1016/j.bja.2020.12.047.