Association of sleep disordered breathing symptoms with early postoperative analgesic requirement in pediatric ambulatory surgical patients

Abstract

Introduction Sleep disordered breathing (SDB) symptoms are associated with increased rates of opioid-induced respiratory depression as well as enhanced nociception. Consequently, practitioners often withhold or administer lower intraoperative doses of opioids out of concern for postoperative respiratory depression. Therefore, SDB may be a critical determinant of analgesic requirement in the post-anesthesia care unit (PACU). We investigated whether preoperative SDB classification was independently associated with need for PACU analgesic intervention in a cross-sectional sample of 985 children who underwent elective, painful ambulatory surgical procedures. Methods Using prospectively collected data, children aged 4–17yr were grouped into two categories based on whether or not they had symptoms of SDB. Perioperative variables were compared between the exposed and control groups using Chi-squared test for categorical or t-test for continuous variables. Logistic regression analysis was used to assess the association between SDB and the odds of requiring PACU IV opioids. Results Children with preoperative SDB symptoms (N=325) compared with the reference group of children who did not have these symptoms had higher rates of PACU analgesic intervention (47.1% vs. 37.4%; p=0.004) and higher mean arousal pain scores (3.7±3.5 vs.1.9±2.9; p<0.001). In our primary multivariable logistic regression model adjusted for a number of variables, preoperative SDB symptoms was associated with a two-fold increased odds of receiving PACU intravenous opioid (OR = 2.01, 95%CI, 1.29–3.12; p=0.002). Conclusion These results suggest that preoperative SDB symptoms in children undergoing ambulatory surgery, exerts a significant influence on PACU pain behavior and analgesic requirement. Mechanisms underlying this enhanced pain experience deserve further elucidation.

Current Pediatric Tertiary Care Practices Following Adenotonsillectomy: An Update

“…We hypothesize that children with SDB have a heightened sensitivity to pain, requiring additional forms of medication for further control. This is supported by an investigation on 985 children, whereby 325 (33%) having SDB required higher rates of opioids in the PACU compared to those without SDB, in addition to postoperative higher mean pain arousal scores 38 . To that end, the likelihood of requiring a form of opioid for pain control may be justified.…”

“…This is supported by an investigation on 985 children, whereby 325 (33%) having SDB required higher rates of opioids in the PACU compared to those without SDB, in addition to postoperative higher mean pain arousal scores. 38 To that end, the likelihood of requiring a form of opioid for pain control may be justified. Another possibility is that many practices are having difficulty moving away from postoperative narcotic use as it has been a mainstay in the treatment of post-tonsillectomy pain for decades.…”