Family exemplars during implementation of a home pain management intervention

Postoperative pain and symptom management at home following pediatric tonsillectomy and adenoidectomy (T & A) is challenging. There are few randomized clinical trials that have established postoperative care interventions that are specific and effective during home recovery. The purpose of this pilot feasibility study was to describe how children and their families implemented a randomly assigned alarm intervention designed to promote postoperative around-the-clock administration of analgesics. Thirteen children from 12 through 18 years of age were randomly assigned to either the around-the-clock (RTC) intervention group (n = 7) or the usual care group (UCG) of controls (n = 6). The RTC intervention group was requested to use an alarm as a reminder to awaken and administer analgesia during the nighttime hours of sleep. Children randomly assigned to the UCG of controls were given the same discharge education as the RTC intervention group that emphasized around-the-clock administration of analgesia. The UCG of controls were not requested to use the alarm intervention. Both groups documented pain intensity and other symptoms daily for 3 days in a diary. All children wore an actigraphy-score wrist monitor to assess sleep during the same 3 days. Telephone interviews were conducted with the children and mothers at 24 hours and 10 to 14 days after surgery. Nonparametric statistics were used to compare differences between the two groups. Children in the RTC intervention group administered significantly (p = .014) more analgesics by the second postoperative day than the UCG of controls. Pain intensity was moderate to severe for both groups. The mean hours of nighttime sleep for the two groups did not differ. Themes that emerged from the qualitative analysis of the interviews included painful challenges; struggling with decisions; making things work; a lengthy recovery; and family support. Results supported the need for research to establish evidenced-based home care interventions specific for T & A postoperative recovery. Mothers and children suggested the need for education and support that extends longer into the recovery period.