Related Experiment Video
Updated: Aug 21, 2025
Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery
Published on: June 2, 2022
Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology
Dana B Gal1, Caitlin O Clyde2, Erin L Colvin3
1The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
This clinical practice guideline addresses significant practice variation in managing postoperative pain in children after cardiac surgery. It provides 60 consensus-based recommendations for optimal pain management from pre-operation to discharge.
Area of Science:
- Pediatric Cardiac Surgery
- Pain Management
- Clinical Practice Guidelines
Background:
- Postoperative pain following pediatric cardiac surgery is common, with significant variation in management practices.
- Optimal pain management is crucial for recovery and outcomes in these young patients.
- Existing center-specific protocols highlight the need for standardized approaches.
Purpose of the Study:
- To develop a clinical practice guideline for managing postoperative pain in pediatric cardiac surgery patients.
- To reduce practice variation and improve the consistency of pain management strategies.
- To provide evidence-based recommendations for optimal perioperative pain control.
Main Methods:
- Convened a multidisciplinary expert panel including pediatric cardiologists, surgeons, anesthesiologists, pharmacists, and advanced practitioners.
- Conducted a comprehensive literature search and reviewed center-specific protocols.
- Utilized a modified Delphi technique with iterative rounds to achieve expert consensus on recommendations.
Main Results:
- Achieved consensus on 60 recommendations covering all aspects of postoperative pain management.
- Recommendations address guideline use, pain assessment, preoperative, intraoperative, and discharge considerations.
- Specific recommendations include regional anesthesia, opioid and non-opioid medications, and non-pharmaceutical interventions.
Conclusions:
- Significant practice variability persists in pediatric cardiac surgery postoperative pain management.
- Effective pain management requires a comprehensive approach from preoperative counseling through discharge.
- The quality of evidence is generally low, underscoring the need for further research in pediatric populations.
Background:
Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline.
Methods:
A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus.
Results:
60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations.
Conclusions:
Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:22Aneurysm IV: Nursing Management
01:26Cardiac Catheterization IV: Nursing Management
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...