Effect of parental anxiety and catastrophizing on post-tonsillectomy opioid consumption in children

Background

The impact of parental psychological factors on post-operative pain management in children is not well understood, but is important. The aim of this study was to determine the relationship between parental anxiety, pain catastrophizing about child pain, and opioid administration in children undergoing tonsillectomy.

Methods

This was a multicenter prospective cohort study from four different centers between 2022 and 2023. All parents of children undergoing adenotonsillectomy were included. Parental levels of anxiety and pain catastrophizing were assessed using the State-Trait Anxiety inventory (STAI), a Numeric Anxiety Scale (NAS), and the Pain Catastrophizing Scale-Parent Version (PCS-P). Post-operative analgesia data was collected on post-operative days (POD) 1, 3, 7, and 10.

Results

236 patients were included. Mean child age was 5.1 years old (SD 2.8). Mean baseline parental PCS-P score was 34.4 and NAS was 6.1. Higher PCS-P and NAS scores corresponded to increased odds of opioid administration in the early postoperative period (POD 1 and 3 [aOR 1.16, 95 % CI [1.03–2.99])). Children with a communication delay (aOR 4.75, 95 % CI [2.35–9.59]) and young children (aOR 1.73, 95 % CI [1.45–2.56]) also had increased opioid administration in the early postoperative period (POD1 & 3).

Conclusion

Parents who have higher anxiety and tendencies to catastrophize are more likely to administer opioids early in the postoperative period. Children with limited communication skills are more likely to receive greater amounts of opioids after tonsillectomy. Interventions such as targeted screening for parental mental health, peri-operative counseling, and tailored pain control programs represent promising avenues for improving pain management.