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Pain status and sedation level in Chinese children after cardiac surgery: an observational study
1School of Nursing, Tianjin Medical University, Tianjin, China.
Insights
Postoperative pain and sedation management in Chinese children after cardiac surgery showed variable analgesic and sedative use. While pain scores were generally low, over-sedation was common, highlighting a need for improved care strategies.
Area of Science:
- Pediatric Critical Care Medicine
- Pain Management
- Sedation Monitoring
Background:
- Effective pain and sedation management are crucial in pediatric critical care after major surgery.
- These management practices are often under-implemented in pediatric populations undergoing significant surgical procedures.
Purpose of the Study:
- To explore the current pain status and sedation levels in Chinese children following cardiac surgery.
- To investigate the trajectories of pain and sedation over the initial postoperative days.
Main Methods:
- A repeated observational study design was employed.
- 170 children undergoing cardiac surgery in Shanghai were observed.
- Pain and sedation were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and the COMFORT Behaviour Scale, respectively, at 18 time-points over three postoperative days.
Main Results:
- Over half of the children (55.9%) received continuous opioids, while 35.9% received no analgesics.
- Sedative use was frequent, with phenobarbital (68.8%) and promethazine (47.6%) being common.
- Pain scores decreased significantly from postoperative day 0 to day 2, with less than 5% of observations indicating moderate to severe pain.
- Sedation scores increased significantly over the same period, with a high rate of over-sedation (50.3%) and minimal under-sedation (<1%).
- Longer intensive care unit (ICU) stays predicted increased analgesic use (OR: 1.72).
Conclusions:
- Analgesic and sedative agent usage in the cardiac ICU was inconsistent.
- Children experienced low pain scores but a high incidence of over-sedation.
- Healthcare providers need to enhance postoperative pain and sedation management strategies for this patient group.
- Accurate monitoring using reliable tools is essential for optimizing pediatric pain and sedation care.
Aims And Objectives:
This study explored current pain status, sedation level and their trajectories in Chinese children after cardiac surgery. Background. Pain and sedation management are fundamental care practices in the critical care setting, yet they both are frequently under-implemented for children after major surgery.
Design:
Repeated observational design.
Methods:
This study was conducted in a paediatric medical centre in Shanghai, China where 170 children who underwent cardiac surgery were recruited. Pain was measured with the face, legs, activity, cry, consolability scale and sedation levels with the COMFORT Behaviour Scale at 18 fixed time-points for three consecutive postoperative days. Results. The study indicated that 95 children (55·9%) received continuous opioids for pain relief, and 61 children (35·9%) received no analgesics. Multiple sedatives were used for these children, including bolus phenobarbital for 117 children (68·8%), phenergan for 81 children (47·6%) and midazolam for three children (1·8%). The mean pain scores significantly decreased throughout the operation day (POD-0) to the 2nd postoperative day (POD-2) with the lowest score on POD-2. Less than 5% of pain assessments were identified as moderate to severe across all 2815 observations. The sedation scores significantly increased through POD-0 to POD-2 with the highest score on POD-2. The rate of over-sedation was 50·3% with <1% under-sedation occurring among all the observations. Results also suggested that the length of stay in the cardiac intensive care unit was a predictor of increased analgesic usage in the critical care setting (odds ratio: 1·72).
Conclusions:
Usage of analgesic and sedative agents in cardiac intensive care unit was variable and children experienced low pain scores but a high rate of over-sedation, indicating that healthcare providers should address ways to improve postoperative pain and sedation management in this population.
Relevance To Clinical Practice:
The pain and sedation status for children after cardiac surgery changed across the postoperative days. Healthcare providers should be trained in the use of reliable tools to accurately monitor children's pain and sedation levels.
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