This prospective, observational study evaluates the effectiveness of perioperative pain management strategies in pediatric patients undergoing elective surgical procedures. Pediatric patients aged 0-18 years were assessed using age-appropriate pain scales during the first postoperative hour to measure acute pain control. Pain scores, emergence delirium evaluations, and interventions administered during routine clinical care were recorded to determine the effectiveness of standard pain management approaches across age and surgical subgroups. This study will not interfere with the clinician's treatment methods in any way. The treatments applied and their frequency will be determined. The success of the procedures performed will also be evaluated.

Pain management in pediatric patients remains challenging despite advances in medical techniques. Limited availability of centers performing high-risk pediatric operations, narrow therapeutic dose ranges of medications used in children, and limited clinical experience contribute to persistent difficulties in pain management. Evidence indicates that many surgical patients experience acute postoperative pain, and a significant proportion do not receive adequate pain relief. Inadequate pain control has been associated with prolonged hospital stay, respiratory complications, infection, and delayed recovery.

Improvements in outcomes observed with advances in pain management techniques highlight the importance of effective postoperative analgesia in pediatric populations. Adequate pain control in the early postoperative period reduces complications and may prevent the development of chronic pain syndromes.

This prospective, observational study is designed to evaluate postoperative pain management strategies applied in pediatric patients undergoing elective surgical procedures performed by the Pediatric Surgery Department. The study focuses on the frequency and effectiveness of multimodal analgesia and regional anesthesia techniques used in routine clinical practice.

Pain management strategies in pediatric patients are supported by international pain societies; however, challenges persist due to concerns regarding invasive procedures in younger children, limitations in opioid use, and variability in clinical experience. Regional anesthesia techniques, neuraxial analgesia, and patient-controlled analgesia are routinely applied in the institution, and evaluation of their clinical effectiveness and complication rates is intended to contribute to existing literature.

The study is conducted in the Pediatric Surgery Operating Rooms of Hacettepe University Hospital and includes pediatric patients undergoing elective procedures under general anesthesia. Patients are stratified into age groups to account for differences in pain perception and assessment ability. Early postoperative evaluation includes assessment of recovery status to minimize the influence of postoperative delirium on pain scoring.

Postoperative pain assessment is performed using age-appropriate scales:

FLACC scale for children aged 0-5 years, Wong-Baker FACES scale for children aged 5-7 years, Visual Analog Scale (VAS) for children aged 7 years and older.

Data collection is performed prospectively. Following admission to the operating room, demographic characteristics, anesthesia techniques, surgical procedures performed, regional anesthesia applications, perioperative analgesic strategies, and intraoperative analgesic agents potentially affecting postoperative pain outcomes were recorded prospectively. Patients were monitored in the postoperative recovery unit for the first hour, which is considered the period during which acute postoperative pain is most intense. No modifications were made to routine anesthesia or analgesia practices, as the study was designed to observe and document routine clinical management without intervention.

Postoperative pain was assessed using age-appropriate scales. Pain scores ≥4 were considered indicative of pain requiring intervention, whereas scores ≥7 were accepted as reflecting insufficient pain control.

To differentiate pain-related agitation from postoperative emergence delirium, the Postoperative Anesthesia Emergence Delirium (PAED) scale was also used. Patients with PAED scores ≥10 were evaluated as having postoperative delirium. Because delirium may falsely elevate pain scores, pain assessments were performed concurrently with PAED evaluation after recovery. Pain assessment was repeated following the resolution of delirium symptoms. Patients whose delirium persisted despite appropriate treatment were excluded from analysis to prevent confounding effects on pain evaluation.

During the first postoperative hour, pain scores, PAED scores, and vital signs were recorded at 0 , 30, and 60 minutes in the recovery unit. Analgesic or delirium-related interventions administered according to clinical need, as well as the timing of these treatments, were also documented.

To improve comparability among procedures expected to produce similar postoperative pain levels, surgical interventions will be categorized into groups during data analysis. Pain outcomes and management strategies will be evaluated within comparable surgical and age subgroups to obtain a more homogeneous assessment of pain control success.Postoperative hospital stay duration is also recorded to evaluate potential associations between pain management success and recovery outcomes.

The study aims to provide observational data regarding current postoperative pain management practices pediatric surgical patients and to evaluate the effectiveness of routinely applied perioperative analgesic strategies.

Inclusion Criteria:

• Patients aged 0-18 years operated on by the Pediatric Surgery Department,
• Elective pediatric operations are performed under general anesthesia,
• ASA I-III group patients,

Exclusion Criteria:

• o Hemodynamically unstable patients. o ASA IV-VI group patients with life-threatening conditions. o Patients requiring emergency surgery.

  0 Patients requiring emergency surgery. o Patients over 18 years of age,

  • Patients admitted under sedation,
  • Non-surgical diagnostic or minimally invasive procedures such as gastroscopy, colonoscopy, bronchoscopy, and direct laryngoscopy,
  • Non-surgical needle biopsies,
  • Catheter placement and removal procedures,
  • Pain management interventions for chronic pain patients (TENS, Acupuncture),
  • Neurological (patients with chronic analgesic syndrome, peripheral neuropathies, spinal cord injury, cerebral palsy, meningomyelocele, multiple sclerosis, and neurodegenerative diseases) and mental developmental delay (autism spectrum disorders, mental retardation, Down syndrome),
  • Patients being followed up and treated for psychiatric illnesses (depression, anxiety disorder, somatization disorder, conversion disorder, schizophrenia, and bipolar disorder),
  • Patients with chronic pain syndrome or neuropathic pain who are using continuous analgesics in the preoperative period. Patients with a history of drug and psychoactive substance use, patients who are intubated postoperatively or monitored under intensive sedation for a long period, patients who are hemodynamically unstable in the postoperative period, patients who develop serious postoperative complications (hemorrhage, sepsis, MOOS), patients who require repeat surgery during the postoperative follow-up period, patients for whom Informed Consent could not be obtained will be excluded from the study.

Eligible pediatric patients undergoing elective surgery were consecutively enrolled during the study period.