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

## TL;DR

This study found that children with severe sleep apnea undergoing surgery experience similar pain levels as others, despite receiving less opioid medication, and that severe sleep apnea reduces pain sensitivity differences between boys and girls.

## Contribution

The study reveals that severe OSA reduces sex-based pain sensitivity differences in pre-pubertal children.

## Key findings

- Children with severe OSA received less opioid medication but had similar post-operative pain scores as others.
- Female children in the less severe OSA group had higher pain scores than males, but not in the severe OSA group.
- Severe OSA blunts sex differences in acute pain perception in pre-pubertal children.

## Abstract

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.

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.

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.

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.

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.