Pain assessment following general anesthesia using the toddler preschooler postoperative pain scale: A comparative study

Abstract

Study objectives To evaluate the reliability of the Toddler Preschooler Postoperative Pain Scale (TPPS) following general anesthesia as a guide to analgesic administration, and to compare the validity of this scale with other observational measures of pain in children. Design Prospective, consecutive, single-blinded observational study. Setting Operative and radiology suites at a community hospital. Patients 51 ASA physical status I and II patients aged 1 to 5 years requiring general anesthesia. Interventions Patients emerging from general anesthesia following elective otolaryngology, urology, and nonpainful radiology procedures were observed. Persons caring for the children were blinded as to the purpose of the observers. The observers recorded pain scores during recovery, before and after analgesic administration and at discharge. Measurements The TPPS was used in three sequential stages. The initial stage (n = 20) examined pain scores from emergence through discharge from hospital following myringotomy, adenoidectomy, or tonsillectomy. The second stage compared these pain scores to those observed on emergence from nonpainful diagnostic radiologic procedures (n = 11) and patients receiving caudal analgesia following urological procedures (n = 8). The third stage studied the clinical utility of the TPPS in comparison to the face, legs, activity, crying, consolability (FLACC) scale and a modified COMFORT scale using simultaneous measurements (n = 12). Main results TPPS scores varied in a categorical fashion with the intensity of pain and significantly decreased following opioid administration. All three scales reliably demonstrated pain reduction following opioid administration. Initial TPPS scores tended to be lower in patients who did not require treatment for pain. Conclusions Following procedures that are likely to produce pain, TPPS, FLACC, and the COMFORT scale, modified as a purely behavioral tool, can be recommended for postoperative assessment of patients aged 1 to 5 years. The TPPS may be preferred for the discrimination between painful and nonpainful states.