Factors Associated With Moderate‐to‐Severe Pain After Paediatric Laparoscopic Pyeloplasty: Implications for Nursing Care

BACKGROUND: Moderate-to-severe pain remains a clinically relevant concern after paediatric laparoscopic pyeloplasty and may interfere with early recovery. Identifying children at increased risk may support more timely and individualized perioperative pain management. AIMS: To investigate factors associated with moderate-to-severe pain after laparoscopic pyeloplasty in children and to inform targeted nursing and perioperative management strategies. METHODS: This single-centre retrospective observational study included children undergoing laparoscopic pyeloplasty. Postoperative pain was assessed at 2, 6, 12 and 24 h using either a Faces Pain Scale or the Face, Legs, Activity, Cry and Consolability (FLACC) scale according to age and communication ability. Moderate-to-severe pain was defined as a score ≥ 4 at any assessment within 24 h. Demographic, disease-related, surgical and perioperative variables were analysed. Multivariable binary logistic regression was used to identify factors independently associated with moderate-to-severe pain, and repeated-measures analysis of variance was used to assess changes in pain scores over time. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: Among 258 children, 65 developed moderate-to-severe postoperative pain, corresponding to an incidence of 25.2%. Multivariable analysis showed that age < 3 years, significant preoperative anxiety, operative time ≥ 120 min and the absence of a regional block were independently associated with moderate-to-severe pain. Sex, severe hydronephrosis and postoperative drainage tube placement were not independently associated with the outcome. Pain scores were highest at approximately 6 h after surgery, with significant group, time and group-by-time interaction effects. CONCLUSION: Moderate-to-severe pain is relatively common during the early postoperative period after paediatric laparoscopic pyeloplasty. Early risk identification, preoperative psychological support, appropriate regional analgesia and intensified pain assessment during the first 6-12 h may improve perioperative pain management. Prospective multicentre studies are warranted to validate these findings and develop clinically applicable risk-stratification strategies.