What children and parents report at home after ambulatory surgery

Abstract

This un-blinded RCT investigated the effectiveness of imagery, in addition to routine analgesics, in reducing pain and other outcomes after discharge from an ambulatory surgery setting (AS) for a tonsillectomy and/or adenoidectomy. Seventy-three children, ages 7–12, were recruited from five AS settings. Thirty-six children randomly assigned to the treatment group listened to a 30-minute audio tape of imagery both before surgery (M = 3.78 times) and after surgery at home (M = 1.58 times). The 37 children in the attention-control group received standard care. Measures of sensory pain were the Oucher and amount of analgesics used. Affective pain was measured with the Facial Affective Scale (FAS). All children, with help from parents, were asked to keep a home diary of fluid intake, pain measures report, and analgesics given in the first day after surgery. Analysis was performed using parametric tests or corresponding non-parametric tests when necessary. There were no significant differences between the groups on length of AS stay, number of emesis, total amount of fluid intake, and analgesics administered while at home (p g .05). However, the amount of fluid intake at home was significantly lower than the minimum recommended by the American Academy of Otolaryngology (p < .02). Pain scores at home indicate that children experienced moderate pain in the first 24 hours. Oucher scores averaged 37.25 (SD = 24.76) and FAS scores averaged 0.56 (SD = 0.21). Children prescribed hydrocodone and acetaminophen as analgesic (n = 33), received significantly less than the recommended mg/kg/dose (p < .0001), with 97% of these children receiving less than suggested dosing. All children over 50 kg (n = 13) received less than recommended doses of either hydrocodone or codeine. Teaching parents about adequate home administration of analgesics and fluids are essential for postoperative recovery at home.