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An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Pain relief in children following outpatient surgery
H M Munro1, S Malviya, G R Lauder
1Section of Pediatric Anesthesiology, University of Michigan Medical Center, Ann Arbor 48109, USA. hmunro@umich.edu
Insights
Most children experience adequate pain relief after outpatient surgery, with parents effectively managing their care at home. This suggests current patient selection for ambulatory surgery is appropriate for pediatric pain management.
Area of Science:
- Pediatric Surgery
- Pain Management
- Ambulatory Care
Background:
- Outpatient surgery for children is increasingly common.
- Effective pain management and parental care are crucial for successful ambulatory surgery outcomes.
Purpose of the Study:
- To evaluate perioperative analgesia, prescription patterns, and pain relief in children undergoing outpatient surgery.
- To assess parental ability to manage children's pain and care post-discharge.
Main Methods:
- Prospective data collection from 471 children (10 months-18 years) undergoing outpatient surgery.
- Parental interviews at 24 hours post-surgery to gather data on pain relief, medication use, and care.
- Analysis of perioperative data including analgesia, antiemetics, and pain scores.
Main Results:
- 97% of children reported acceptable pain relief within 24 hours post-surgery.
- Poor pain relief was associated with increased postoperative nausea/vomiting and difficulty in home care.
- Regional analgesia in genitourinary procedures correlated with better pain relief.
Conclusions:
- Current patient selection for pediatric outpatient surgery is appropriate.
- Parents are generally capable of managing their children's pain and care at home post-ambulatory surgery.
- Effective perioperative analgesia and parental support are key to successful pediatric ambulatory surgery.
Study Objective:
To evaluate perioperative analgesia, prescription patterns, pain relief, and parental care of children undergoing outpatient surgery.
Design:
Prospective data collection and parental interview.
Setting:
Large tertiary care, university-based medical center.
Patients:
471 children aged between 10 months and 18 years who underwent an outpatient surgical procedure expected to be associated with pain.
Measurements And Main Results:
All perioperative data regarding analgesia, antiemetics, postoperative pain scores, and discharge prescriptions were recorded. Parents were telephoned 24 hours following surgery, and data concerning their child's pain relief, analgesic and antiemetic usage, and their ability to care for their child were obtained. Of the 460 patients questioned, 97% were described by their parents as having adequate, good, or very good pain relief (acceptable) during the first 24 hours postoperatively, whereas only 15 (3%) had poor pain relief (unacceptable). All patients received some form of analgesia intraoperatively. The children with poor pain relief were more likely to have experienced postoperative nausea and vomiting (p = 0.01) and were more difficult to care for at home (p < 0.0001). In a subset of 185 patients who had genitourinary procedures, those who received regional analgesia reported better pain relief (p = 0.05).
Conclusions:
Despite a wide range of surgical procedures being performed on children on an ambulatory basis, current selection of patients for outpatient surgery is appropriate given the ability of the parents to manage their children's pain and to care for their children at home.
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