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Updated: Jul 4, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Maximum Pain at Rest in Pediatric Patients Undergoing Elective Thoracic Surgery and the Predictors of
Lucyna Tomaszek1,2, Dariusz Fenikowski1, Nina Cież-Piekarczyk1,3
1Department of Thoracic Surgery, Institute of Tuberculosis and Lung Diseases, Rabka-Zdrój Branch, 34-700 Rabka-Zdrój, Poland.
Insights
Pediatric thoracic surgery patients often experience moderate-to-severe pain. Intravenous morphine and specific epidural analgesia reduce pain, while older age increases risk. Understanding these factors improves pediatric pain management.
Area of Science:
- Pediatric Anesthesiology
- Thoracic Surgery Pain Management
- Postoperative Pain Research
Background:
- Pain management after pediatric thoracic surgery shows significant practice variation.
- Identifying risk factors for moderate-to-severe pain is crucial for effective pain relief.
Purpose of the Study:
- To determine maximum pain intensity at rest within 24 hours post-thoracic surgery in pediatric patients.
- To investigate the prevalence and predictors of moderate-to-severe pain.
Main Methods:
- Prospective cohort study with secondary data analysis from 446 pediatric patients (aged 7-18).
- Primary endpoint: maximum pain intensity (Numerical Rating Scale, NRS 0-10).
- Secondary endpoint: prevalence and predictors of moderate-to-severe pain (NRS > 2/10).
Main Results:
- Median maximum pain intensity was 3 (range 0-4).
- 54% of patients reported moderate-to-severe pain (NRS > 2/10).
- Intravenous morphine, specific epidural analgesia (bupivacaine with morphine/fentanyl), and younger age (7-13) were protective factors. Older age (14-18) increased pain risk.
Conclusions:
- Analgesic route, multimodal analgesia type, and patient age are key predictors of moderate-to-severe pain post-pediatric thoracic surgery.
- Optimizing pain management strategies based on these predictors is essential.
Introduction:
Pain management among children following thoracic surgery is an area of significant practice variability. Understanding the risk factors of moderate-to-severe pain intensity will allow for adequate pain relief. The aim of the study was to assess the maximum intensity of pain at rest in pediatric patients within 24 h of thoracic surgery and to investigate the prevalence and predictors of moderate-to-severe pain.
Methods And Findings:
This is a prospective cohort study of patients in observational and randomized controlled trials following thoracic surgery. A secondary analysis of data was conducted using data collected from 446 patients aged 7-18 years undergoing thoracic surgery. The primary endpoint was maximum pain intensity (Numerical Rating Scale; NRS; range: 0-10) and the secondary endpoint was the prevalence and predictors of moderate-to-severe pain (NRS > 2/10). The median maximum pain in the cohort was 3 [0; 4]. During the immediate postoperative period, 54% of patients reported a maximum NRS > 2/10. The infusion of morphine by an intravenous route (vs. epidural route) was a protective factor against moderate-to-severe pain. Taking into account the findings related to the type of epidural analgesia (vs. intravenous morphine), it was found that only the administration of 0.25% bupivacaine combined with morphine or fentanyl was a protective factor against moderate-to-severe postoperative pain. Patients aged 14-18 years (vs. aged 7-13 years) had an increased risk of reporting pain as moderate-to-severe.
Conclusions:
The route of analgesic administration, type of multimodal analgesia, and patients' age predict moderate-to-severe pain in pediatric patients after thoracic surgery.
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