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<p>To evaluate postoperative pain trajectories, voluntary analgesic requirements, and early recovery patterns in children undergoing coblation intracapsular tonsillectomy (ICT) with adenoidectomy for obstructive sleep apnea syndrome (OSAS). This was a multicentric prospective observational study involving ENT departments across multiple hospitals in Kerala, India, from June 2024 to June 2025. Fifty-two children aged 3–12 years with OSAS attributed to adenotonsillar hypertrophy were included and underwent ICT after informed parental consent. Pain was assessed daily using a validated parent-proxy visual analogue scale (VAS, 0–10) incorporating numerical and facial pain rating components. Analgesic use followed a single-agent, voluntary protocol permitting paracetamol (15&#xa0;mg/kg/dose, up to three times daily) only if the child reported pain. Data were analysed using the Friedman test for repeated measures with Kendall’s W as the effect size measure; post-hoc pairwise comparisons were conducted using Dunn’s test with Bonferroni correction. Analgesic discontinuation was analysed using a Kaplan-Meier time-to-event framework. Mean pain scores declined from 4.07 ± 1.42 on POD 0 to 2.73 ± 1.18 on POD 1, 1.50 ± 0.98 on POD 2, and 0.64 ± 0.75 (median 0) on POD 3, becoming negligible by POD 4–7. [ADDED] The Friedman test confirmed a highly significant overall temporal decline (χ²F(7) = 308.1, <i>p</i> &lt; 0.001, Kendall’s W = 0.847). Significant stepwise reductions were observed between all adjacent pairs from POD 0 to POD 3 (Dunn’s test, Bonferroni-corrected <i>p</i> &lt; 0.001 for all). The median time to analgesic discontinuation was POD 1; 76.9% of children had ceased paracetamol by POD 1 and 100% by POD 3. No primary or secondary haemorrhages occurred. Outcomes were consistent across all participating centres. Coblation ICT is associated with rapid pain resolution and minimal analgesic requirements in children with OSAS. These findings are descriptive in nature, derived from an observational cohort without a contemporaneous extracapsular comparator. The contribution of routine postoperative corticosteroid administration to early pain scores should be noted. The consistency of recovery patterns across multiple centers supports the reproducibility of this technique as a patient-friendly, recovery-oriented option in pediatric sleep-disordered breathing.</p>

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Postoperative Pain and Analgesic Requirements Following Coblation Intracapsular Tonsillectomy in Children: A Multicentric Prospective study

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Sanu Pulinganal Moideen,
  • Ramiya Ramachandran Kaipuzha,
  • Neenu Anna Joseph,
  • Ahsain Kalam,
  • Jabir Bin Umer Karerat Parakkandathail,
  • Nithin Mohan,
  • Jayalekshmi Punnakkuttickal Appukuttan,
  • Sruthy Krishna,
  • Davis Thomas Pulimoottil

摘要

To evaluate postoperative pain trajectories, voluntary analgesic requirements, and early recovery patterns in children undergoing coblation intracapsular tonsillectomy (ICT) with adenoidectomy for obstructive sleep apnea syndrome (OSAS). This was a multicentric prospective observational study involving ENT departments across multiple hospitals in Kerala, India, from June 2024 to June 2025. Fifty-two children aged 3–12 years with OSAS attributed to adenotonsillar hypertrophy were included and underwent ICT after informed parental consent. Pain was assessed daily using a validated parent-proxy visual analogue scale (VAS, 0–10) incorporating numerical and facial pain rating components. Analgesic use followed a single-agent, voluntary protocol permitting paracetamol (15 mg/kg/dose, up to three times daily) only if the child reported pain. Data were analysed using the Friedman test for repeated measures with Kendall’s W as the effect size measure; post-hoc pairwise comparisons were conducted using Dunn’s test with Bonferroni correction. Analgesic discontinuation was analysed using a Kaplan-Meier time-to-event framework. Mean pain scores declined from 4.07 ± 1.42 on POD 0 to 2.73 ± 1.18 on POD 1, 1.50 ± 0.98 on POD 2, and 0.64 ± 0.75 (median 0) on POD 3, becoming negligible by POD 4–7. [ADDED] The Friedman test confirmed a highly significant overall temporal decline (χ²F(7) = 308.1, p < 0.001, Kendall’s W = 0.847). Significant stepwise reductions were observed between all adjacent pairs from POD 0 to POD 3 (Dunn’s test, Bonferroni-corrected p < 0.001 for all). The median time to analgesic discontinuation was POD 1; 76.9% of children had ceased paracetamol by POD 1 and 100% by POD 3. No primary or secondary haemorrhages occurred. Outcomes were consistent across all participating centres. Coblation ICT is associated with rapid pain resolution and minimal analgesic requirements in children with OSAS. These findings are descriptive in nature, derived from an observational cohort without a contemporaneous extracapsular comparator. The contribution of routine postoperative corticosteroid administration to early pain scores should be noted. The consistency of recovery patterns across multiple centers supports the reproducibility of this technique as a patient-friendly, recovery-oriented option in pediatric sleep-disordered breathing.