Postoperative analgesia in children undergoing adenotonsillectomy under sevoflurane versus propofol-based anesthesia: a randomized controlled trial

Background
The field of pediatric pain management has changed greatly in the past decades. However, the number of children who experience moderate-to-severe postoperative pain, even with analgesic treatment, remains significant. If an intravenous or inhalational anesthetic would include in itself all components of general anesthesia, such as hypnosis, analgesia, and amnesia, it would represent an ideal anesthetic. There are some pieces of evidence that propofol may reduce postoperative pain. This debate on the early potential analgesic efficacy of propofol compared with sevoflurane during the postoperative period in children was evident. The aim of this study is to compare the postoperative potential analgesic effects of propofol-based versus sevoflurane-based anesthesia in children undergoing adenotonsillectomy.
Methods
This study was a prospective comparative randomized, double-blinded trial conducted on 60 children between 3 and 10 years of age and American Society of Anesthesiologists physical status I and ІІ undergoing adenotonsillectomy under general anesthesia. Patients were randomly assigned to one of the following two equal groups: the sevoflurane group and the propofol group. The primary outcome was pain score assessed using the Faces Pain Scale postoperatively. The secondary outcomes included recovery time and adverse events within the first 4 h.
Results
The current study showed that the postoperative resting and swallowing face pain score was significantly lower in the propofol group than in the sevoflurane group, and postoperative agitation scores were significantly lower in the propofol group than in the sevoflurane group during the first 30 min of early postoperative period. No significant differences were found from 40 min to the fourth postoperative hour. Paracetamol consumption during the 4-h postoperative period was significantly greater in the sevoflurane group than in the propofol group, and the incidence of postoperative nausea and vomiting was lower in the propofol group than in the sevoflurane group ( = 0.001).
Conclusion
The use of propofol is more advantageous compared with sevoflurane for the induction and maintenance of general anesthesia in children undergoing adenotonsillectomy. It decreases early postoperative pain, analgesic consumption, postoperative agitation, and postoperative nausea and vomiting. However, the use of propofol in the induction and maintenance of anesthesia is associated with a prolonged recovery time.