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Henri Tuomilehto, MD; Hannu Kokki, MD; Riitta Ahonen, PhD; Juhani Nuutinen, MD

Arch Otolaryngol Head Neck Surg. 2002;128:1159-1164.

Background  Pain is a common complaint after adenoidectomy. Behavioral changes after adenoidectomy in children have been reported, and it has been concluded that postoperative pain significantly affects the occurrence of behavioral changes. Behavioral changes, when a proactive pain treatment has been used, have not been systematically studied.

Objective  To assess postoperative behavioral changes in children who have undergone day-case adenoidectomy with proactive pain treatment.

Design  Prospective, longitudinal, randomized clinical trial.

Settings  Ambulatory Care Unit, Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

Patients  Three hundred consecutive children, aged 1 to 10 years, who underwent day-case adenoidectomy during 1999 through 2000.

Intervention  In the hospital, 213 children received the first dose of ketoprofen before surgery and 87 children received the first dose at discharge. For pain treatment after discharge, patients were given ketoprofen tablets or suppositories on a regular basis for 72 hours.

Main Outcome Measures  The number of postoperative behavioral changes were evaluated with 3 consecutive questionnaires, at baseline before surgery, 1 week after surgery, and 3 weeks after surgery.

Results  A total of 294 questionnaires (98%) were returned after 1 week and 255 questionnaires (85%) after 3 weeks. Most children (91%) had pain after discharge and the mean for pain cessation was 3 days (range, 0-8 days). The mean of ketoprofen doses after discharge was 6 (range, 1-24 doses). Most of the children showed no or only trivial postoperative behavioral changes, and, furthermore, at 3 weeks, more positive than negative changes were reported. The child's age was a significant factor (P< .05) in affecting behavioral changes for all domains. Other significant factors were the worst pain at rest (P = .04) and during swallowing (P = .02) for daytime function disturbances, and fear of separation from parents (P = .03) for sleep disturbances.

Conclusion  Day-case adenoidectomy with proactive pain treatment seems to result in a negligible incidence of behavioral troubles in children.

From the Departments of Otorhinolaryngology (Drs Tuomilehto and Nuutinen), Anesthesiology and Intensive Care (Dr Kokki), and Social Pharmacy (Dr Ahonen), Kuopio University Hospital, Kuopio, Finland.