Related Experiment Video
Updated: Dec 31, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Reducing postoperative pain in children undergoing strabismus surgery: From bundle implementation to clinical
Usman Ali1, Maisie Tsang1,2, Fiona Campbell1,2
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Insights
Postoperative pain in children undergoing strabismus surgery was significantly reduced by implementing a perioperative care bundle. This quality improvement project decreased pain incidence by over 50%, improving patient outcomes.
Area of Science:
- Pediatric Anesthesia
- Quality Improvement Science
- Pain Management
Background:
- Postoperative pain is a major cause of morbidity in pediatric anesthesia.
- Children undergoing strabismus surgery face a high risk of postoperative pain, leading to potential complications.
- Effective pain management strategies are crucial for pediatric surgical patients.
Purpose of the Study:
- To decrease moderate to severe postoperative pain by 25% in children undergoing strabismus surgery.
- To implement and evaluate an evidence-based perioperative care bundle.
- To enhance patient recovery and reduce hospital stay duration.
Main Methods:
- A multidisciplinary quality improvement project utilizing the Plan-Do-Study-Act methodology.
- Implementation of a perioperative bundle including acetaminophen, dexamethasone, ketorolac, long-acting opioids, and anti-emetics.
- Utilized email reminders, results dissemination, and clinical decision aids to improve compliance.
Main Results:
- Reduced incidence of moderate to severe postoperative pain from 47.3% to 21%.
- Achieved a mean bundle compliance rate of 78.7%.
- No significant change in the mean length of postanesthesia care unit (PACU) stay.
Conclusions:
- An evidence-based bundle of care effectively decreased postoperative pain in pediatric strabismus surgery patients.
- Combining nudge theory with quality improvement methodology yielded positive results.
- The implemented strategies improved patient outcomes and pain management.
Background:
Postoperative pain is a significant cause of morbidity in pediatric anesthesia, which can result in delayed discharge and unplanned hospital admission. Children undergoing strabismus surgery are known to be a particularly high-risk group for postoperative pain.
Aim:
The aim of this project was to reduce the incidence of moderate to severe postoperative pain by 25% over a period of 12 months in children undergoing strabismus surgery.
Methods:
This was a multidisciplinary quality improvement project using the Institute for Healthcare Improvement model for improvement and iterative Plan-Do-Study-Act cycles. Baseline data from one hundred patients were collected retrospectively from patient records. Subsequently, iterative interventions introduced comprised: a perioperative bundle (comprising preoperative acetaminophen, intraoperative dexamethasone and ketorolac, a long-acting opioid, and two anti-emetics), email reminders, dissemination of results at departmental rounds, and an intraoperative clinical decision aide. Postoperative pain data were collected as an outcome measure, and length of stay in PACU was monitored as a balancing measure. Statistical process control charts were constructed to monitor bundle compliance and incidence of postoperative pain in the postanesthesia care unit.
Results:
Postoperative pain and bundle compliance data were collected for 1127 children in total. Baseline mean monthly incidence of moderate to severe postoperative pain was 47.3%. By the conclusion of this project, the incidence of postoperative pain decreased to 21%. Concurrently, mean bundle compliance increased to 78.7%. Mean length of PACU stay for baseline audit patients was 72.5 min compared with 70 min for patients after the introduction of the strabismus macro (November 2018-April 2019, n 91) (mean difference, 2.5; 95% CI, -3.86 to 8.86; P = .439).
Conclusion:
Through the implementation and adoption of an evidence-based bundle of care, we successfully decreased the incidence of moderate to severe postoperative pain for children undergoing strabismus repair. We demonstrated that combining nudge theory with QI methodology can be an effective means of delivering positive results in quality improvement projects.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:25Analgesia and Pain Management