A Retrospective Study on Pain Sensitivity in Pediatric Patients with Severe Obstructive Sleep Apnea Undergoing Adenotonsillectomy

Background: Regarding post-adenotonsillectomy pain management, pediatric patients with severe obstructive sleep apnea (OSA) are often treated with lower total opioid doses, and with more short-acting opioid types, relative to their non-severe OSA counterparts. It is unclear whether this practice undermines these patients’ pain management and exposes them to a traumatic experience due to under-managed surgical pain. Pain sensitivity differs between adult males and females. Whether the difference exists in the pediatric population, especially related to surgical pain sensitivity, is unclear. Objectives: We explored the differences in pain sensitivity between sexes using a pediatric adenotonsillectomy population and studied the effects of sleep apnea on acute pain responses. Methods: We retrospectively analyzed perioperative pain management approaches in a pediatric adenotonsillectomy surgical population at our medical center. Patients aged 3 to 12 years were grouped into those with less severe OSA or severe OSA. Perioperative pain medications and post-anesthesia care unit (PACU) pain assessments were compared between two groups. Results: Of a total 3,586 patients we analyzed, a higher percentage of severe OSA patients received non-opioid type analgesic medications, as well as fewer and shorter-acting opioids. The use of rescue opioids in the post-operative period did not significantly increase in patients with severe OSA. Post-operative pain scores did not differ between patients with and without severe OSA status. Female patients had significantly higher post-operative pain scores than males in the less severe OSA group, but sex differences in the severe OSA group were not significant. Conclusions: Despite receiving less perioperative opioid, pediatric patients with severe OSA did not demonstrate worse pain scores in post-surgical recovery. Overall, we did not under-manage their post-operative pain with reduced dosages of opioids. We did find that a sex difference in acute pain perception exists even in pre-puberty pediatric population. However, severe OSA reduces pain sensitivity in both sexes, and blunts sex differences in acute pain perception.