Quality Assessment of Postoperative Pain Management in Pediatric Surgical Patients

Abstract

Objective: To evaluate the incidence of moderate to severe pain in children during 24 hours following surgery, including their risk factors, analgesic treatment and complications.
Methods: A retrospective descriptive study was conducted at a university hospital from 1 March 2003 to 28 February 2004. Children aged 1-15 years, ASA 1-2, who underwent major operation at the Department of Surgery were recruited into the study. Postoperative pain was assessed by age-appropriated scales at least 10 times in the first 24 hours postoperatively. Their demographic data, type of operation, anesthetic technique, medication and complication were recorded.
Results: Two hundred and thirty children, median age of 8 years interquartile range (IQR) 4-11 years were recruited. They received surgical operations on various regions of the bodies, namely: groin/perineum, head/neck/face, extremity and abdomen/trunk with the following percentages: 24.3%, 10.9%, 3.5% and 59.1%, respectively. Incidents of moderate to severe pain in the first 24 hours occurred in 100 patients (43.5%). Their risk factors included age > 6 years old (adjusted OR 2.21) and inadequacy of analgesic treatment (adjusted OR 38.80). Pethidine IV and oral paracetamol on PRN basis were commonly prescribed with too long dosing interval. The common postoperative complication identified was nausea and vomiting (19.6%). No respiratory depression was detected.
Conclusion: Postoperative pain in children was still under-treated. More attention should be provided to children > 6 years old. Proper prescription of analgesic dosing interval, frequent assessment and appropriate criteria for treatment on PRN basis tended to reduce pain.