Title : Comparative evaluation of pupillary parameters with FLACC pain scale for postoperative analgesia in pediatric patients: An observational study
Abstract:
Background: Postoperative pain is an acute response to surgical trauma. An objective understanding of pain measurement is essential for adequate postoperative pain management. Infants and the pediatric population often have limited language skills to express their discomfort clearly, necessitating the use of observation- based scales. In recent years, pupil dilation has emerged as a recognized reflex response to nociceptive stimuli. The present study aimed to evaluate the effectiveness of pupil diameter measurements by comparing them with FLACC pain scores in pediatric patients undergoing infraumbilical surgeries.
Methods: The present prospective, observational study was conducted at Pediatric OT complex of a tertiary Hospital in 42 patients undergoing infraumbilical surgeries . The surgery was planned under General Anaesthesia with intravenous induction and i.gel insertion , Caudal analgesia was administrated for postoperative pain management .In the postoperative room reading of pupillometry was taken and FLACC pain score was assessed simultaneously, then follow-up was done every 2 hourly for 12 hours using FLACC pain scale . The correlation between FLACC pain scores and pupillary parameters were analyzed using the Pearson correlation coefficient. Data were expressed as mean ± standard deviation (SD) or median (interquartile range, IQR) as appropriate. A p-value <0.05 was considered statistically significant.
Results: A positive correlation was observed between pupil diameter (r = 0.45, p = 0.002) and variance (r = 0.4, p = 0.005) with the FLACC score, indicating that larger pupil size and greater variance after caudal analgesia were associated with higher pain scores. The ROC curve with an AUC of 0.909 indicates excellent discrimination in predicting postoperative pain using the test variable.
Conclusions: This study supports the integration of pupillometry into pediatric pain assessment as an adjunct to existing observational pain scales. With further validation, it has the potential to revolutionize pain assessment, ensuring more precise and individualized pain management strategies for pediatric patients undergoing surgery.
