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[Better postoperative pain management in children by introduction of guidelines; a prospective study]
M T Huntink-Sloot1, R Faber-Nijholt, R P Zwierstra
1Afd. Anesthesiologie, Academisch Ziekenhuis, Groningen.
Insights
Implementing new recommendations significantly improved children's postoperative pain scores. This enhancement in pain management quality was observed without significant changes in analgesic prescriptions, suggesting a shift in attitude towards pain management may be responsible.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Clinical Quality Improvement
Context:
- Postoperative pain management in children is a critical aspect of pediatric care.
- Assessing and managing pain in pediatric patients presents unique challenges.
- Standardized recommendations aim to improve the consistency and effectiveness of pain relief.
Purpose:
- To evaluate the impact of interdisciplinary recommendations on the quality of postoperative pain management in children.
- To assess changes in pain scores and analgesic prescribing practices following the implementation of new guidelines.
- To identify factors contributing to improved pain management outcomes in pediatric surgical patients.
Summary:
- A prospective study in a university hospital investigated pain management quality in children (0-14 years) before and after implementing new interdisciplinary recommendations.
- Pain scores, assessed using the Children's Hospital of Eastern Ontario pain scale (CHEOPS) and Oucher scale, showed statistically significant improvement post-recommendation.
- No significant differences in analgesic prescription patterns were found, indicating that improved pain scores may be linked to attitudinal changes rather than medication adjustments.
Impact:
- The study demonstrates that formalized recommendations can lead to better postoperative pain control in children.
- Findings suggest that a shift in healthcare providers' attitudes towards pediatric pain may be a key driver of improved outcomes.
- The results highlight the importance of considering patient self-reporting capabilities and age-specific needs in pain management strategies.
Objective:
To investigate the influence of recommendations on the quality of postoperative pain management in children.
Design:
Prospective.
Setting:
University Hospital Groningen, the Netherlands.
Method:
After interdisciplinary recommendations on postoperative pain were developed, the quality of postoperative pain management was investigated before implementation (phase I; n = 50 children aged 0-14 who underwent elective surgery), three months after the implementation (phase II; n = 51), and nine months later (phase III; n = 50). Quality was defined by a pain score (for ages 0 to 4 with the 'Children's Hospital of Eastern Ontario pain scale' (CHEOPS) and for ages 4-14 with the Oucher scale) and the prescription of analgetics: kind, dose, frequency, prescription by anaesthetist and doctor on the ward. Pain was scored every 2 hours during the first 24 hours after surgery. A CHEOPS score < or = 6 an Oucher score < or = 50 was defined as adequate; higher scores were defined as inadequate.
Results:
Pain measurement showed a statistically significant improvement of pain scores in time (phase II and III compared with phase I: odds ratio: 2.5; 95% confidence interval: 1.03-6.00; p < 0.01). Searching for factors that could be responsible for this improvement, like medication, we found no statistically significant differences in everyday practice in phase II and III compared with phase I. However, children who could score their pain by self-report (Oucher) showed the best results in all 3 phases of the study. The youngest children, i.e. less than 6 months old, showed inadequate results during the whole study. The greatest improvement in time during the first 12 hours was seen in the group of children older than 6 months. The recommendations were followed more strictly in younger children, and when continuous morphine was given.
Conclusion:
Pain scores in children improved after the introduction of recommendations on postoperative pain. However, the improvement could not be attributed to factors like medication. Factors like a change in attitude towards pain could be responsible for this change.