Abstract
ObjectiveThe purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration. MethodsThis is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain). ResultsA significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1–3 (30.05%–35.95%). Of those pairs in disagreement, the majority of parents overestimated their child's pain on all three postoperative days, specifically such that a total of 24–26% parents overestimated their child's pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. ConclusionsSince parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.
Highlights
Research indicates that up to 75% of all children undergoing surgery in the United States experience significant postoperative pain.[1]
Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents. Since parents overestimate their child’s postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing tonsillectomy and adenoidectomy (T&A)
Once we identified which parent-child dyads were in disagreement on each of the three postoperative days, all parent-child dyads included in the study were categorized into one of 3 groups: parents who overestimated their child’s pain (OE), parents whose pain ratings were in agreement with child ratings (A), and parents who underestimated their child’s pain (UE)
Summary
Research indicates that up to 75% of all children undergoing surgery in the United States experience significant postoperative pain.[1]. [11,14,17,18,19] These previous studies suffer from a number of methodological flaws and have focused on describing pain rating disagreement and not predictors or clinical impact of such disagreement. We submit that assessing the impact of disagreement on actual clinical practice is of paramount importance and, if it is discovered that such a disagreement does not have any impact on clinical care or outcomes, pain rating discrepancies between parents and children are less significant. If such disagreement has clinical impact, it is highly important to identify predictors for such disagreement
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