Br J Anaesth. 2025 Nov 27:S0007-0912(25)00665-8. Revista: 10.1016/j.bja.2025.09.015. Online ahead of print.
BACKGROUND: Obstructive sleep-disordered breathing (oSDB) is pro-inflammatory and might modulate pain. We hypothesised that post-adenotonsillectomy pain and analgesic use would correlate with oSDB severity.
METHODS: We conducted a prospective cohort study of children aged 2-12 yr undergoing adenotonsillectomy. Symptom severity of oSDB was assessed with the modified Snoring, Trouble Breathing, Un-Refreshed (mSTBUR) questionnaire. Parents recorded the Parents’ Postoperative Pain Measure (PPPM) and analgesic medications for 14 postoperative days (PODs).
RESULTS: Complete PPPM data (2480 scores) for 10 PODs were recorded for 124/245 (51%) patients. An additional 1539 PPPM scores were recorded in 121 patients; imputed values were derived for 941 missing PPPM scores. In this dataset (n=245), group-based trajectory models identified three trajectory groups for mild/brief (Trajectory1, n=108), moderate (Trajectory2, n=90), and severe/prolonged (Trajectory3, n=47) pain. Trajectories exhibited distinct PPPM scores on POD1. Children with higher preoperative mSTBUR scores were significantly less likely to be in the low or moderate pain trajectory groups compared with the severe pain group (odds ratio [OR], 0.52; 95% confidence interval [95% CI], 0.27-0.97; P=0.040 and OR, 0.58; 95% CI, 0.35-0.97; P=0.037). The association between mSTBUR and the PPPM scores was stronger for younger children. When compared with Trajectory1, children in Trajectory2 and Trajectory3 received more daily doses of analgesics (P=0.04) and had, respectively, four-fold and 11-fold higher odds for unscheduled revisits (OR, 3.5; 95% CI, 1.0-11.7; P=0.044 and 10.5; 95% CI, 3.1-35.7; P=0.0002).
CONCLUSIONS: Post-adenotonsillectomy pain at home followed three distinct pain trajectories. Children with severe oSDB (higher mSTBUR scores) were more likely to have severe prolonged pain and to return more often to hospital.
CLINICAL TRIAL REGISTRATION: NCT03378830.
PubMed:41314942 | Revista:10.1016/j.bja.2025.09.015