Related Experiment Video
Updated: Aug 9, 2026
Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Improved pain management in pediatric postoperative liver transplant patients using parental education and
Paul J Sharek1, Karen Wayman, Eugenia Lin
1Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. psharek@lpch.org
Insights
A new pain management program for pediatric liver transplant patients significantly reduced pain scores and improved parent perception of pain. This approach enhanced patient care without increasing hospital stay or costs.
Area of Science:
- Pediatric Surgery
- Pain Management
- Transplant Medicine
Background:
- Liver transplantation in children presents significant postoperative pain challenges.
- Effective pain management is crucial for pediatric transplant recovery and outcomes.
- Non-pharmacologic strategies are increasingly recognized for their role in multimodal pain control.
Purpose of the Study:
- To evaluate the impact of a comprehensive non-pharmacologic pain management intervention for pediatric liver transplant recipients.
- To compare pain scores, parent perception, and resource utilization before and after intervention implementation.
Main Methods:
- A quasi-experimental study comparing pediatric liver transplant patients pre- and post-intervention.
- Intervention included parental education, behavioral consultations, and non-pharmacologic pain strategies.
- Outcomes assessed: pain scores, parent perception, length of stay, ventilator days, cost, and opioid use.
Main Results:
- The intervention group showed a significant decrease in mean pain scores (p=0.047) and parent pain perception (p=0.001).
- There was a significant increase in pain assessments per shift (p<0.005) in the intervention group.
- No significant differences were observed in length of stay, ventilator days, total cost, or opioid use.
Conclusions:
- A comprehensive non-pharmacologic pain management program effectively reduced pain and improved parent perception in pediatric liver transplant patients.
- This approach enhanced pain management without negatively impacting hospital resource utilization.
- The findings support the integration of non-pharmacologic strategies into pediatric transplant pain protocols.
Abstract:
A pain management intervention, consisting of pretransplant parental education and support, pre- and postoperative behavioral pediatrics consultation, postoperative physical and occupational therapy consultation, and implementation of non-pharmacologic pain management strategies, was introduced to all pediatrics patients receiving liver transplants at Lucile Packard Children's Hospital beginning August 2001. Children receiving transplants pre-intervention (May, 2000 to February, 2001) and post-intervention (August, 2001 to March, 2002) were compared using pain scores, parent perception of pain ratings, length of stay, ventilator days, total cost, and opioid use. A total of 27 children were evaluated (13 historical control, 14 intervention). The two populations did not differ on age at transplant (mean age 53.8 vs. 63.6 months), sex (46.1% vs. 50% male), ethnicity (53.8% vs. 57.1% white, non-Hispanic) weight at transplant (17.5 vs. 24.7 kg), percent with biliary atresia as the primary reason for transplant (42.9% vs. 69.2%), percent with status 1 transplant listing score (38.5% vs. 50.0%), or public insurance status (30.8 vs. 57.2% with Medicaid). No differences were found in mean pediatric intensive care unit (PICU) postoperative length of stay (6.7 vs. 5.3 days), total postoperative length of stay (17.5 vs. 17.5 days), total inpatient length of stay (27.0 vs. 24.4 days), time to extubation (30 vs. 24.3 h), total cost (dollar 147,983 vs. dollar 157,882) or opioid use through postoperative day (POD) 6 (0.24 vs. 0.25 mg/kg/day morphine equivalent). A decrease in mean pain score between POD 0 and 6 (2.82 vs. 2.12; p = 0.047), a decrease in mean parental pain perception score (3.1 vs. 2.1; p = 0.001), and an increase in number of pain assessments per 12 h shift (3.43 vs. 6.79; p < 0.005) were seen. A comprehensive non-pharmacologic postoperative pain management program in children receiving a liver transplant was associated with decreased pain scores, improved parent perception of pain, and an increased number of pain assessments per 12 h shift. No increases in lengths of stay (PICU, postoperative, total), time to extubation, or total cost were found.
Related Concept Videos
01:16Kidney Transplant III: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:26Kidney Transplant II: Surgical Procedure