Assessment of postoperative pain in children following sclerotherapy of vascular malformations: a retrospective single centre cohort study

Inadequately controlled postprocedural pain following sclerotherapy in patients with vascular malformations is a well recognised problem. Reliable epidemiological data and risk factors associated with postprocedural pain in children are lacking. To evaluate and quantify postprocedural pain in children and identify possible risk factors based on characteristics of the patient, treatment, and medication. A retrospective single centre cohort study. A tertiary single centre study in the Netherlands. Two hundred and nine chiuldren with ‘simple’ subtypes of congenital vascular malformation who had undergone sclerotherapy. Quantifying inadequately controlled postprocedural pain. Identifying potential patient and treatment characteristics associated with inadequately controlled postprocedural pain. A total of 209 patients who underwent 679 procedures were included in this study. The mean age at first intervention was 11.8 ± 4.5 years. Inadequately controlled postprocedural pain was found in 34.8% of the 679 procedures. Venous malformations (VM) were the most prevalent subtype of vascular malformation (80%), followed by arteriovenous malformations (AVM) (14.6%) and lymphatic malformations (LM) (5.4%). The odds ratio (OR) (95% confidence intervals), and P values obtained from multivariable mixed effect logistic regression analysis for patient and treatment characteristics found to be associated with inadequately controlled postprocedural pain were: chronic use of analgesics (OR 2.74 (1.40 to 5.34), P = 0.003), treatment with ethanol (OR 2.39 (1.01 to 5.65, P = 0.05) or esketamine (OR 7.43 (1.32 to 41.81), P = 0.02). Patients treated with lauromacrogol (OR 0.42 (0.22 to 0.82, P = 0.01) and patients receiving intra-operative NSAIDs (OR 0.32, (0.12 to 0.85), P = 0.02) were less likely to experience inadequately controlled postprocedural pain. Despite aiming to achieve best practice, the 34.8% incidence of unsatisfactory postoperative pain management in the children studied confirms that postprocedural pain after sclerotherapy is a common problem that requires further attention.