Postoperative pain management in children: Comparing pain scores in open vs laparoscopic surgeries

Background: Postoperative pain in children is a critical determinant of recovery and overall surgical outcomes. The choice of surgical approach, particularly open versus laparoscopic surgery, may significantly influence pain intensity and analgesic requirements. Objective: To compare postoperative pain scores in children undergoing open versus laparoscopic surgeries and to evaluate associated analgesic requirements and recovery outcomes. Methods: This comparative cross-sectional analytical study was conducted at Ghulam Muhammad Mahar medical college Sukkur from march 2025 to march 2026 including 310 pediatric patients aged 2–14 years undergoing abdominal surgery. Patients were divided into open (n=156) and laparoscopic (n=154) groups. Results: The mean age was 8.6 ± 3.2 years. Pain scores were significantly higher in the open group at 6 hours (6.8 ± 1.4 vs 5.1 ± 1.2), 12 hours (5.9 ± 1.3 vs 4.3 ± 1.1), and 24 hours (4.8 ± 1.2 vs 3.5 ± 1.0) (p<0.001). Time to first analgesia was shorter in open surgery (1.8 ± 0.6 vs 3.2 ± 0.9 hours; p<0.001), with higher analgesic doses (4.6 ± 1.2 vs 3.1 ± 1.0; p<0.001) and greater opioid use (47.4% vs 27.3%; p=0.001). Hospital stay was longer in open cases (4.9 ± 1.5 vs 3.2 ± 1.1 days; p<0.001). Complications including nausea/vomiting (33.3% vs 23.4%; p=0.048), wound infection (11.5% vs 3.9%; p=0.015), and fever (21.8% vs 13.0%; p=0.041) were more frequent in open surgery. Conclusion: Laparoscopic surgery is associated with lower postoperative pain, reduced analgesic requirements, shorter hospital stay, and fewer complications compared to open surgery in children, supporting its preference when feasible.

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