Comparison of postoperative pain and agitation scores in pediatric patients undergoing adenotonsillectomy surgery

Introduction: Adenotonsillectomy is one of the most commonly performed surgical procedures in children. Postoperative pain and agitation are frequently observed in pediatric patients undergoing adenotonsillectomy. Various scoring systems are used to assess postoperative pain and agitation in children. The aim of this study is to evaluate the correlation between different scoring systems used in assessing postoperative pain and agitation in children, to investigate whether there is a correlation between intraoperative vital signs and postoperative pain and agitation, and to contribute to the development of effective analgesia and agitation management strategies. Materials and Methods: This prospective observational study was conducted at the Department of Otorhinolaryngology, Karadeniz Technical University Faculty of Medicine, between October 2024 and December 2024. A total of 136 patients aged 2– 10 years who underwent adenotonsillectomy were included in the study. The demographic characteristics of the patients and their intraoperative hemodynamic and respiratory parameters (heart rate [HR], noninvasive blood pressure [mean arterial pressure (MAP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP)], SpO₂ [peripheral oxygen saturation], and EtCO₂ [end-tidal carbon dioxide]) were recorded at baseline, 5 minutes after induction, at surgical incision, 5 and 10 minutes after incision, before extubation, and after extubation. Postoperative agitation levels were evaluated using the PAED (Pediatric Anesthesia Emergence Delirium) and WATCHA scales, while pain levels were assessed using the CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) and FLACC (Face, Legs, Activity, Cry, Consolability) scales at 0, 5, 10, and 15 minutes during recovery. Results: PAED, FLACC, and CHEOPS scores at 5, 10, and 15 minutes of recovery showed a significant decrease compared to the 0-minute scores (p<0.05). WATCHA scores at 10 and 15 minutes of recovery also showed a significant reduction compared to the baseline (p<0.05). A significant positive correlation was observed between the PAED and WATCHA agitation scores, as well as between the FLACC and CHEOPS pain scores at 0 and 15 minutes of recovery (p<0.05). Pain and agitation scores showed a progressive decline throughout the recovery period. Heart rate increased significantly at 5 minutes after induction, at surgical incision, 5 and 10 minutes after incision, before and after extubation compared to baseline values (p<0.05). Systolic, diastolic, and mean arterial pressures significantly decreased at 5 minutes after induction, at surgical incision, 5 and 10 minutes after incision, and before extubation compared to baseline values (p<0.05). No significant relationship was found between heart rate and postoperative pain and V agitation scores, except for the CHEOPS pain score, which was significantly higher in patients with elevated intraoperative heart rates. No significant association was found between mean arterial pressure and postoperative pain or agitation scores. Conclusion: Objective evaluation of postoperative pain and agitation in children is crucial for appropriate intervention. A positive correlation between pain and agitation was identified in our study. In addition to commonly used scoring systems, we observed that newer scoring systems can provide an objective perspective in assessing postoperative pain and agitation in children. Objective methods such as standardized scoring systems should be more widely implemented in clinical practice. Each clinic should determine the scoring systems most suitable for their patient population and use them consistently in daily practice. Key Words: Adenotonsillectomy, Postoperative agitation, Postoperative pain, FLACC, CHEOPS, PAED, WATCHA.