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An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomy
Chantal Frigon1, Witthaya Loetwiriyakul, Manon Ranger
1Department of Anesthesiology, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada. chantal.frigon@muhc.mcgill.ca
Insights
An organized acute pain service (APS) significantly reduced postoperative oxygen desaturation and hospital stays for children undergoing selective dorsal rhizotomy (SDR). This improved pain management and patient outcomes after surgery.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Healthcare Services Research
Background:
- Continuous epidural morphine infusion is standard pain management for pediatric selective dorsal rhizotomy (SDR).
- The impact of an organized acute pain service (APS) on postoperative pain management for these children was evaluated.
Purpose of the Study:
- To assess the effectiveness of an organized acute pain service (APS) in improving postoperative pain management for pediatric patients undergoing SDR.
- To compare pain control, side effects, and hospital length of stay before and after APS implementation.
Main Methods:
- Retrospective cohort study analyzing anesthetic records and APS database (January 1997 - July 2006).
- Comparison of postoperative pain, opioid-induced side effects, sedation, desaturations, and hospital length of stay in children undergoing SDR before and after April 2001 (APS introduction).
- Ninety-two pediatric patients were included in the study.
Main Results:
- Pain score documentation increased post-APS implementation (61% vs. 48.5%).
- Postoperative desaturation incidence significantly decreased in the APS group (6.8% vs. 45.5%, P < 0.001).
- Hospitalization duration was reduced by one day in the APS group (median 5 days vs. 6 days, P < 0.001).
Conclusions:
- An organized APS significantly decreased postoperative oxygen desaturation in pediatric SDR patients.
- Implementation of an APS led to a one-day reduction in hospital length of stay.
- While other care changes may have contributed, the APS demonstrated a positive impact on key postoperative outcomes.
Background:
A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children.
Methods:
We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations < 92%), and hospital length of stay.
Results:
Pain scores were documented more frequently after the implementation of the APS (61% vs 48.5%). Sedation scores were documented only after the implementation of the APS. Postoperative desaturation was significantly more frequent in the pre-APS group compared to the APS group (45.5% vs 6.8%, P < 0.001). Despite the fact that the epidural catheter was in place for the same duration for both groups [median of 3 days (3-3 25-75%ile)], the duration of hospitalization was 1 day shorter in the APS group compared to the pre-APS group [median of 5 (5-5 25-75%ile) vs 6 (5-6 25-75%ile) days, P < 0.001].
Conclusions:
Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day.
