# Force Metrics During the Boyle–Davis Gag in Children Undergoing Adenotonsillectomy

## TL;DR

The study found that the force used during a surgical tool called Boyle–Davis Gag in children's throat surgery is not linked to pain or opioid use afterward.

## Contribution

This study is the first to measure force metrics during the Boyle–Davis Gag in children and assess their relation to postoperative outcomes.

## Key findings

- Intraoperative force metrics are not associated with opioid requirements, emergence delirium, or hypoactive delirium.
- Suspension time is weakly and inversely associated with postoperative pain severity.
- Force metrics during the Boyle–Davis Gag are low in children compared to adults.

## Abstract

What are the main findings?
There is no association between intraoperative force metrics and opioid requirements, emergence delirium, or hypoactive delirium following adenotonsillectomy in pediatric patients.Suspension time is weakly and inversely associated with the severity of postoperative pain.

There is no association between intraoperative force metrics and opioid requirements, emergence delirium, or hypoactive delirium following adenotonsillectomy in pediatric patients.

Suspension time is weakly and inversely associated with the severity of postoperative pain.

What are the implications of the main findings?
This study provides initial reference values of force measurements of the Boyle–Davis Gag suspension during adenotonsillectomy in children.Routine monitoring of force during Boyle–Davis Gag suspension may not be useful in decreasing postoperative opioid consumption and pain in children.

This study provides initial reference values of force measurements of the Boyle–Davis Gag suspension during adenotonsillectomy in children.

Routine monitoring of force during Boyle–Davis Gag suspension may not be useful in decreasing postoperative opioid consumption and pain in children.

Background: In adults, the forces generated during Boyle–Davis Gag suspension correlate with postoperative pain, but no data are available in pediatrics. This study investigates the force metrics and postoperative opioid consumption, pain, emergence delirium (ED), and hypoactive delirium in children. Methods: Children undergoing elective partial or total adenotonsillectomy or adenoidectomy were enrolled. Intraoperative maximum and average forces, suspension time, total impulse (area under the curve of force vs. time), and postoperative opioid consumption, pain, ED, and hypoactive delirium were assessed. Results: Data from 43 children were analyzed. Force metrics were not associated with postoperative opioid consumption, ED, or hypoactive delirium. Compared to no pain, total impulse decreased with mild (mean difference 2.3 kN·s; 95% CI, 3.8 to 4.2; p = 0.02), moderate (mean difference 2.8 kN·s; 95% CI, 5.4 to 3.9; p = 0.011), and severe pain (mean difference 2.3 kN·s; 95% CI, 7.6 to 3.9; p = 0.005). Suspension time was negatively correlated with pain score (r = −0.32, p = 0.041). Conclusions: The force metrics are low and not associated with opioid consumption, ED, or hypoactive delirium. Suspension correlates weakly with postoperative pain in children.