Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery

Area of Science:

• Pediatric Nursing
• Neurosurgery
• Pain Management

Background:

• A practice change elevated the head of bed for 3 days post-selective dorsal rhizotomy (SDR) surgery, aiming to enhance pain control.
• This change was implemented without supporting literature, prompting an inquiry into its effectiveness.
• Current pain management strategies include epidural infusions, medication, and repositioning.

Purpose of the Study:

• To determine if altering postoperative head-of-bed elevation impacts pain control in pediatric SDR patients.
• To evaluate the efficacy of a 3-day elevation practice compared to previous protocols.

Main Methods:

• Retrospective cohort study comparing pain medication use before and after the practice change.
• Included patients aged 2-15 years admitted to the neuroscience unit post-SDR.
• Analyzed electronic records for pain medication administration using descriptive and univariate statistics.

Main Results:

• No statistically significant difference in the number of intermittent pain medication doses was found between the groups (P = .661).
• The study analyzed 385 patients, indicating the practice change did not lead to improved pain management outcomes.

Conclusions:

• Findings support reverting to 1 day of flat time post-SDR surgery.
• Reduced flat time may decrease child and parent anxiety without compromising pain control.
• Practice has been updated to zero days of flat time based on these results, with implications for postoperative positioning.