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Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery
Janette Coble1, Lisa M Steurer, Karen Balakas
1Janette Coble, MA BSN RN CNRN, is Staff Nurse, Neuroscience Unit, St. Louis Children's Hospital, St Louis, MO. Karen Balakas, PhD RN, was Manager of Research & Outcomes (retired), St. Louis Children's Hospital, St Louis, MO. Patrick M. Ercole, PhD MPH, is Statistician, Sansom Consulting, Glendale, AZ.
Insights
Elevating the head of bed for children after selective dorsal rhizotomy (SDR) surgery did not improve pain control. Returning to a shorter flat time may reduce patient anxiety without impacting pain management.
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.
Background:
A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain control. Multiple methods to address pain post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain control.
Methods:
A retrospective cohort design was used to compare pain medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain. Descriptive and univariate statistics were used to detect differences.
Results:
The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain between the 2 groups (P = .661).
Discussion:
Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.
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