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

Ulrike M Stamer; Kyra Bernhart; Thomas Lehmann; Maria Setzer; Frank Stüber; Marcus Komann; Winfried Meissner

doi:10.1016/j.bja.2020.12.047

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

Br J Anaesth. 2021 Jun;126(6):1182-1191. doi: 10.1016/j.bja.2020.12.047. Epub 2021 Mar 5.

Authors

Ulrike M Stamer¹, Kyra Bernhart², Thomas Lehmann³, Maria Setzer², Frank Stüber⁴, Marcus Komann⁵, Winfried Meissner⁵

Affiliations

¹ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland. Electronic address: ulrike.stamer@dbmr.unibe.ch.
² Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Institute of Medical Statistics, Computer and Data Sciences, Switzerland.
⁴ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
⁵ Department of Anaesthesiology and Intensive Care, University Hospital Jena, Jena, Germany.

PMID: 33685632
DOI: 10.1016/j.bja.2020.12.047

Abstract

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.

Keywords: appendectomy; desire for more pain treatment; non-opioid analgesics; opioids; paediatric postoperative pain; patient-reported outcomes; tonsillectomy.

Publication types

Multicenter Study

MeSH terms

Adolescent
Age Factors
Analgesics / adverse effects
Analgesics / therapeutic use*
Appendectomy / adverse effects*
Child
Child, Preschool
Europe
Female
Humans
Male
Pain Management* / adverse effects
Pain Measurement
Pain, Postoperative / diagnosis
Pain, Postoperative / etiology
Pain, Postoperative / prevention & control*
Patient Reported Outcome Measures*
Patient Satisfaction
Registries
Risk Assessment
Risk Factors
Time Factors
Tonsillectomy / adverse effects*
Treatment Outcome

Substances

Analgesics