Pre-operative discussion of analgesic goals improves pediatric post-operative pain management

Feb 6th – Pediatrics – Standardized pre-operative discussion of pain management improved post-operative pain control and parental satisfaction in pediatric hernia repair patients.

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1. Standardized pre-operative discussion of pain management improved post-operative pain control and parental satisfaction in pediatric hernia repair patients.

2.  Use of the parent’s post-operative pain measure (PPPM) tool improved management of breakthrough pain.

3.  Over the 8-month study period, surgeons’ analgesic prescribing habits converged to a standard regimen.

This study addresses the challenge of balancing undertreatment of pain with the dangers of analgesic overdose in the pediatric surgical population. The authors successfully implemented an institution-wide, standardized approach to post-operative pain control. The established protocol involved (1) pre-operative discussion of post-operative pain control goals with the parents, (2) documentation of the pain plan in the medical record, (3) meeting parental expectations of the pain plan discussion, and (4) demonstration of successful pain management using the PPPM tool. The authors demonstrate that it is possible to standardize a pain control protocol across providers, and that this improves pain management as well as parental satisfaction.

This study is limited, however, in that post-operative interviews were only conducted for 113 of 235 patients, and discussions about analgesic side effects were only conducted with 93 patients. Additionally, the study relies upon the subjective reporting by parents of their child’s pain experience (with no corroboration from the child), which may introduce bias into the study’s findings.

Click to read the study in Pediatrics

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Image: PD

1. Standardized pre-operative discussion of pain management improved post-operative pain control and parental satisfaction in pediatric hernia repair patients.

2.  Use of the parent’s post-operative pain measure (PPPM) tool improved management of breakthrough pain.

3. Over the 8-month study period, surgeons’ analgesic prescribing habits converged to a standard regimen.

This [prospective] study: tracked the implementation of a standardized protocol for postoperative pain management in a pediatric ambulatory surgical center for 240 days. The protocol was devised through a multidisciplinary workshop and aimed to improve communication about and success of post-operative pain control. During the study period, 235 patients underwent ambulatory hernia repair. Discussion and documentation of the plan of care for post-operative pain control occurred in 73% of pre-operative visits by day 240, and post-operative analgesics were prescribed in 80% of pre-operative visits. Overall, parental satisfaction with the pain plan discussion and the success of pain treatment (assessed using the PPPM tool) ranged from 87 to 100% at 5 days post-procedure. Escalation of care to control breakthrough pain was additionally standardized using the PPPM tool. The majority (8 out of 10) of surgeons adhered to a standardized analgesic regimen by day 240, when statistical variation in analgesics prescribed diminished.

In sum: This study addresses the challenge of balancing undertreatment of pain with the dangers of analgesic overdose in the pediatric surgical population. The authors successfully implemented an institution-wide, standardized approach to post-operative pain control. The established protocol involved (1) pre-operative discussion of post-operative pain control goals with the parents, (2) documentation of the pain plan in the medical record, (3) meeting parental expectations of the pain plan discussion, and (4) demonstration of successful pain management using the PPPM tool. The authors demonstrate that it is possible to standardize a pain control protocol across providers, and that this improves pain management as well as parental satisfaction.

This study is limited, however, in that post-operative interviews were only conducted for 113 of 235 patients, and discussions about analgesic side effects were only conducted with 93 patients. Additionally, the study relies upon the subjective reporting by parents of their child’s pain experience (with no corroboration from the child), which may introduce bias into the study’s findings.

Click to read the study in Pediatrics 

By [EH] and [DB]

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