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Documentation of postoperative pain in the neonatal brachial plexus palsy population
William C Lippert1, Melissa A Miller, Andrew M Lippert
1Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. william_lippert@hotmail.com
Insights
Postoperative pain management for children with neonatal brachial plexus palsy needs improvement. Many patients were not reassessed for pain or received incorrect medication dosages, indicating a need for better clinical guidance and healthcare professional training.
Area of Science:
- Pediatric Surgery
- Pain Management
- Neurology
Background:
- Inadequate postoperative pain management is documented in pediatric populations.
- This study is the first to specifically examine pain management in children with neonatal brachial plexus palsy (NBPP).
Purpose of the Study:
- To evaluate the effectiveness of postoperative pain management strategies in children undergoing surgical procedures for NBPP.
- To identify specific areas for improvement in pain assessment and medication administration for this patient group.
Main Methods:
- Retrospective review of 75 patients with NBPP who underwent nerve repair, release, or transfer procedures.
- Assessment of pain management based on pain scale documentation, medication dosage appropriateness, pain reassessment frequency, and incidence of complications.
Main Results:
- Significant deficiencies were found in pain reassessment post-medication administration (64 patients based on guidelines, 40 based on drug duration).
- 50% of medication administrations were improperly dosed, affecting 51 patients.
- Pain scales were documented incorrectly 20% of the time and administered improperly in 13 patients.
Conclusions:
- Opportunities exist to enhance postoperative pain management for pediatric patients with NBPP.
- Findings suggest potential gaps in healthcare professional knowledge or guidance regarding pediatric pain assessment and documentation, necessitating improved clinical practices and training.
Aims And Objectives:
To assess postoperative pain management in neonatal brachial plexus palsy children who underwent a primary nerve repair, release only and/or a release and transfer procedure.
Background:
Previous studies have noted pain management inadequacies in postoperative pain management in certain paediatric populations. However, this is the first study to focus on postoperative pain management in this particular population.
Methods:
Seventy-five patients, who underwent a primary nerve repair, release only and/or a release and transfer procedures at our institution, were reviewed. Postoperative pain management was assessed on a patient and drug administration level through appropriate pain scale use; appropriate dosage for the medication prescribed; appropriate reassessment of pain following medication administration; and complications leading to a longer hospital stay.
Results:
Based on our institution's guidelines following drug administration, 64 patients were not appropriately reassessed for pain. Based on the drug's duration following drug administration, 40 patients were not appropriately reassessed for pain. Twenty-eight per cent of all medication administrations were not properly reassessed for pain based on the drug's duration and 62% of the time based on our institution's guidelines. Fifty per cent of all medication administrations were not properly dosed and 51 patients were not appropriately dosed at least once during their hospital stay. Pain scales were documented incorrectly 20% of the time and administered improperly to 13 patients.
Conclusions:
Opportunities for improvement in postoperative pain management in the paediatric population - particularly those with neonatal brachial plexus palsy - exist.
Relevance To Clinical Practice:
Findings from this study demonstrate that healthcare professionals may have (1) insufficient knowledge regarding pain and/or (2) inadequate direction and guidance to appropriately assess and document pain in the paediatric population. Improvements for these individual healthcare professionals and clinical settings are needed to overcome postoperative pain management issues in the future.
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