Abstract
Congenital melanocytic nevi need surgical excisions. However, the effect of the size and location of the nevi on pain and emergence agitation have yet to be studied. The objective of this study was to evaluate (1) the ideal parameter of the nevus size and (2) the effects of the size and location of the nevus on pain and emergence agitation. This observational study enrolled 100 children scheduled for an excision of a nevus under sevoflurane anesthesia. The parameters of the nevus size included the long diameter, the area before resection, the area of resection, and the proportion (the area of resection/total body surface). The nevus locations included the trunk, face, scalp, and extremities. The proportion of the nevi was the most ideal parameter in evaluating the pain and emergence agitation. A large size showed a higher emergence agitation than a small size (median (range); 6 (0–20) in small groups vs. 12.5 (0–20) in large groups, p = 0.021). However, the pain was comparable. The nevus location did not influence pain or emergence agitation. In a multivariate regression analysis, a younger age and an extensive excision were associated with higher pain and emergence agitation. In conclusion, large nevi induced more severe emergence agitation. However, the nevus location did not affect the outcome. In addition, a younger age was associated with pain and emergence agitation. Clinicians need to consider the proportion of nevi when managing children undergoing a nevus excision.
Highlights
Congenital melanocytic nevi (CMN) are defined as benign melanocytic nevi that are present at birth
CMN tend to extend deeper into the dermis and subcutaneous tissues compared with acquired melanocytic nevi, and large CMN are associated with a higher risk for melanoma than smaller CMN, the exact risk is unknown
The proportion defined as the ratio of nevi to total body surface (TBS) was the most representative of the postoperative pain and emergence agitation compared with the long diameter, the area before resection, and the area of resection
Summary
Congenital melanocytic nevi (CMN) are defined as benign melanocytic nevi that are present at birth. Nevi being identical CMN are reported to show a prevalence of more than 15% in older children [1]. CMN tend to extend deeper into the dermis and subcutaneous tissues compared with acquired melanocytic nevi, and large CMN are associated with a higher risk for melanoma than smaller CMN, the exact risk is unknown. A large proportion of children are reported to receive insufficient analgesic medication after surgery [3], and suffer from moderate-to-severe postoperative pain up to 44% [4]. Sensitivity to painful stimuli is reported to be affected by the specific body region [6]. The sensitivity in the facial area was higher compared with that in other body regions
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