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Pain assessment following general anesthesia using the Toddler Preschooler Postoperative Pain Scale: a comparative
Craig T Hartrick1, Juliann P Kovan
1Department of Anesthesiology and Perioperative Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073, USA.
Insights
The Toddler Preschooler Postoperative Pain Scale (TPPS) reliably assesses pain in young children after surgery. It effectively guides analgesic administration and distinguishes between painful and non-painful states, similar to FLACC and COMFORT scales.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Clinical Assessment
Background:
- Accurate postoperative pain assessment in young children is crucial for effective analgesic management.
- Existing pain scales require validation for reliability and validity in diverse pediatric surgical populations.
Purpose of the Study:
- To evaluate the reliability and validity of the Toddler Preschooler Postoperative Pain Scale (TPPS) in children aged 1-5 years.
- To compare the TPPS with other observational pain scales (FLACC, COMFORT) for postoperative pain assessment.
- To determine the TPPS's utility in guiding analgesic administration.
Main Methods:
- A prospective, single-blinded observational study involving 51 pediatric patients (1-5 years) undergoing general anesthesia.
- The TPPS was applied in three stages, comparing its scores to pain levels and analgesic administration.
- Simultaneous measurements using the TPPS, FLACC, and a modified COMFORT scale were conducted in a subset of patients.
Main Results:
- TPPS scores demonstrated a clear correlation with pain intensity and decreased significantly after opioid administration.
- All three assessed scales (TPPS, FLACC, COMFORT) reliably indicated pain reduction post-analgesia.
- Initial TPPS scores were lower in patients who did not require pain treatment.
Conclusions:
- The TPPS, FLACC, and modified COMFORT scale are recommended for postoperative pain assessment in children aged 1-5 years.
- The TPPS may be particularly useful for differentiating between painful and non-painful postoperative states.
- These validated scales aid in guiding appropriate analgesic interventions for pediatric surgical patients.
Study Objectives:
To evaluate the reliability of the Toddler Preschooler Postoperative Pain Scale (TPPS) following general anesthesia as a guide to analgesic administration, and to compare the validity of this scale with other observational measures of pain in children.
Design:
Prospective, consecutive, single-blinded observational study.
Setting:
Operative and radiology suites at a community hospital.
Patients:
51 ASA physical status I and II patients aged 1 to 5 years requiring general anesthesia.
Interventions:
Patients emerging from general anesthesia following elective otolaryngology, urology, and nonpainful radiology procedures were observed. Persons caring for the children were blinded as to the purpose of the observers. The observers recorded pain scores during recovery, before and after analgesic administration and at discharge.
Measurements:
The TPPS was used in three sequential stages. The initial stage (n = 20) examined pain scores from emergence through discharge from hospital following myringotomy, adenoidectomy, or tonsillectomy. The second stage compared these pain scores to those observed on emergence from nonpainful diagnostic radiologic procedures (n = 11) and patients receiving caudal analgesia following urological procedures (n = 8). The third stage studied the clinical utility of the TPPS in comparison to the face, legs, activity, crying, consolability (FLACC) scale and a modified COMFORT scale using simultaneous measurements (n = 12).
Main Results:
TPPS scores varied in a categorical fashion with the intensity of pain and significantly decreased following opioid administration. All three scales reliably demonstrated pain reduction following opioid administration. Initial TPPS scores tended to be lower in patients who did not require treatment for pain.
Conclusions:
Following procedures that are likely to produce pain, TPPS, FLACC, and the COMFORT scale, modified as a purely behavioral tool, can be recommended for postoperative assessment of patients aged 1 to 5 years. The TPPS may be preferred for the discrimination between painful and nonpainful states.