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Are children given insufficient pain-relieving medication postoperatively?
J P Hamers1, H H Abu-Saad, M A van den Hout
1Department of Nursing Science, Maastricht University, The Netherlands.
Insights
Postoperative pain in children may be undertreated due to inconsistent pain assessment and a reliance on nurse-administered medications. Standardized pain medication prescriptions are recommended over pro re nata (prn) orders to improve pediatric pain management.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Nursing Practice
Background:
- Literature suggests children are often under-medicated postoperatively.
- Few studies definitively address insufficient pain relief in pediatric patients.
- Lack of consensus on expected pain intensity and cautious prescribing contribute to current practices.
Purpose of the Study:
- To review the literature on postoperative pain management in children.
- To evaluate the effectiveness of current pain relief strategies.
- To determine if children's pain is relieved insufficiently postoperatively.
Main Methods:
- Systematic literature review of studies on pediatric postoperative pain.
- Analysis of factors influencing analgesic administration, including pro re nata (prn) prescribing.
- Examination of the role of nurses' perceptions and knowledge in pain management.
Main Results:
- Evidence is limited on whether pediatric postoperative pain is consistently undertreated.
- Pro re rata (prn) prescribing places decision-making on nurses, potentially leading to under-medication.
- Nurses' underestimation of pain and attitudes towards pain relief impact efficacy.
Conclusions:
- Standard prescription of pain medication is recommended over pro re nata (prn) orders.
- Further research is needed on pain incidence, prevalence, and analgesic effectiveness in children.
- Improved pain management protocols are essential for pediatric postoperative care.
Abstract:
The literature often suggests and assumes that children are under-medicated postoperatively. A review of the literature leads to the conclusion that only a few studies answer the question of whether children's pain is relieved insufficiently. The lack of consensus on expected pain intensity after surgery and caution about prescribing analgesics could explain why analgesics are often prescribed on a pro re nata (prn) basis. Prescription on a prn basis, in fact, means that the nurse makes the decision whether or not an analgesic should be administered. Some studies suggest, however, that nurses under-medicate children and that postoperative pain is relieved insufficiently. In some situations, nurses under-estimate the child's pain, while in others, nurses' attitudes, beliefs and knowledge regarding pain relief strategies play an important role. On the basis of this review of the literature standard prescription of pain medication instead of prn is recommended. Furthermore, research on the incidence and prevalence of pain in children and on the effectiveness of analgesic administration postoperatively is warranted.