Nonpharmacologic Pain Management Techniques Research Articles

Overcoming Cultural Barriers to Managing Labor Pain Among Tanzanian Women Using Non-pharmacological Interventions.

Managing labor pain effectively is crucial for ensuring positive maternal health outcomes. In Tanzania, cultural barriers often hinder the acceptance and utilization of non-pharmacological pain management interventions. This clinical consultation explored strategies for overcoming these cultural barriers to improve labor pain management among Tanzanian women using non-pharmacological interventions. A comprehensive literature review of existing research on non-pharmacological pain management techniques and cultural influences on pain perception and management was conducted, and an observed case study regarding the need to utilize nonpharmacological pain management interventions was also added. Studies indicated that non-pharmacological interventions such as massage, breathing techniques, and relaxation methods are effective and can be culturally adapted to fit Tanzanian women's beliefs and practices. Key barriers to use using these interventions include lack of awareness, limited access to training for healthcare providers, and cultural stigmas associated with pain expression. Successful strategies to overcome these barriers involve community education, involvement of traditional birth attendants, training healthcare providers in cultural competence, and engaging community leaders and family members. Future research should further explore the cultural adaptation and effectiveness of these interventions to ensure their sustainable integration into maternal care practices in countries with limited resources.

Exploring Natural Analgesics for Chronic Pain Management: Cannabinoids and Other Phytoconstituents.

Chronic pain lasting more than three months or persisting after normal healing is a significant global health issue. In a healthcare system, it is crucial to ensure proper chronic pain management. Traditional pharmacological and non-pharmacological pain management techniques may not fully meet the requirements of physicians regarding effectiveness and safety. Therefore, researchers are exploring natural analgesics. Plant-based phytoconstituents show promise in relieving chronic pain associated with various diseases. This study aims to review the latest advances in discovering natural bioactive compounds that can help alleviate chronic pain. It discusses the pathways of chronic pain and a multifactorial treatment strategy. It also organizes data on using plant- derived substances, such as cannabinoids, terpenoids, phenolics, and crude extracts. Additionally, it delves into the pharmacodynamics of cannabinoids, including their route of administration and elimination. The review presents the results of 22 clinical trials on various cannabinoids for pain relief. It is important to note that opioids and other alkaloids from plants are not covered in this article due to their primary use in controlling acute rather than chronic pain.

Evaluate the effectiveness of using non-pharmacological intervention during childbirth: an improvement project in Jordanian maternity hospitals

BackgroundUnnecessary childbirth interventions are still common in most hospitals in Jordan. Despite the recommendations from the WHO that unnecessary interventions during childbirth should be avoided, these interventions are still used. Non-pharmacological pain management interventions are considered a convenient alternative to unnecessary childbirth interventions because they can prevent unsafe side effects for mothers during childbirth. The study aims to determine the feasibility of non-pharmacological pain management interventions during childbirth and then to evaluate their influence on mothers’ experience.MethodsBetween May and June 2022, we implemented a quality improvement project with a bundle of non-pharmacologic comfort measures during childbirth. We started our project by (1) approaching all low-risk pregnant mothers who visited the hospital’s antenatal clinic with a gestational age greater than 36 weeks. (2) Following the agreement, the researcher indicated that she would accompany the mother during the birthing process. (3) The researcher discussed different non-pharmacological pain management techniques and asked the mothers to choose how and when to utilize them. Non-pharmacological pain management techniques include breathing exercises, back massages, enabling mothers to move around, and providing modest amounts of water and soft food. (4) A few days after birth, the mother was interviewed one-to-one utilizing semi-structured audio-recorded interviews. The researcher interviewed eighteen postpartum mothers at a place of their choosing.ResultsThree main themes emerged from the interview analysis. The following themes were selected from the participants’ own words: “Positive, respectful, and satisfying childbirth experience”; “Maintain mother’s sense of control and cope with childbirth pain”; and “Birth outcome”. These themes are connected and impacted by one another.DiscussionDifferent research studies from diverse cultures recommend limiting the unnecessary use of interventions during childbirth and not interfering with childbirth unless medically necessary. Our participants expressed satisfaction with the use of culturally appropriate birth interventions during childbirth. These interventions were generally simple and safe, resulting in a satisfying birthing experience.ConclusionThe study findings contribute to achieving Sustainable Development Goal #3, “Good health and well-being” by reducing maternal and neonatal mortality, providing evidence of the effectiveness of non-pharmacological pain management, and avoiding unnecessary childbirth interventions.

Teaching Strategies for Nonpharmacological Pain Management to Nursing Students

BackgroundPain management is an essential concept to be integrated throughout undergraduate nursing curricula. Many studies have identified a lack of knowledge in pain assessment and management among nurses. Educators have significant roles in preparing students with pain knowledge and application of alternative nonpharmacological pain management techniques. AimThe purpose of this research study was to explore the impact of instruction on nonpharmacological pain management techniques in both didactic and simulated laboratory settings on nursing students’ application of these techniques in clinical settings. DesignA mixed-method descriptive study, with a survey that included closed and open-ended questions. ParticipantsThe sample included 144 first-semester senior prelicensure baccalaureate nursing students. MethodInvestigators developed two research questionnaires. All students were given nonpharmacological pain management instruction didactically and practiced in the simulation lab and a hospital-based obstetrical practicum under faculty supervision. The students completed research questionnaires at the semester's conclusion and again prior to graduation. ResultsStudents reported that they implemented taught nonpharmacological pain management techniques in the clinical setting under faculty supervision. A review of the follow-up questionnaire indicates that graduating seniors did implement the nonpharmacological pain management techniques in other clinical settings and plan to utilize them in their future nursing practice. ConclusionsTeaching nonpharmacological pain management techniques didactically, in a simulation lab and a supervised clinical setting contributes to students’ ability to apply these techniques. The findings of this study have implications for nursing education and students’ future clinical practice to foster their utilization of nonpharmacological pain management techniques across all settings.

Application Of Pbm-Nir Therapy For Postpartum Mother's Discomfort In Maternity Nursing Care

Normal post partum is post partum discomfort due to uterine involution. Uterine involution in patients can cause pain in the uterus called afterpains. Discomfort caused by uterine involution requires various treatments to minimize the pain felt by the mother so that the mother's comfort can return. This can be overcome with non-pharmacological pain management strategies through innovative near infrared phototherapy or near infrared photobiomodulation (PBM NIR). The aim of this research is to analyze the results of implementing pain management with non-pharmacological PBM NIR therapy in normal post-partum mothers with post-partum discomfort nursing problems. Case study that focuses on the implementation of non-pharmacological nursing pain management techniques with PBM NIR therapy. The case study subjects were 3 normal post-partum maternal patients with the same problem, namely post-partum discomfort in the obstetrics room at the Muhammadiyah Hospital in Palembang. The results of the study showed that the implementation of non-pharmacological pain management techniques with PBM NIR therapy had an effective effect on dealing with post-partum discomfort with complaints of decreased discomfort, decreased moaning, and strong uterine contractions. Implementation of pain management can improve the comfort status of normal postpartum mothers. This study makes an important contribution to understanding of the role of nonpharmacological techniques in postpartum pain management, as well as highlighting the importance of implementing innovative therapies for labor, as well as highlighting the importance of implementing innovative therapies to improve the quality of care in postpartum mothers.

Comparison of breastfeeding, music therapy, and oral sucrose's impact on pain relief among infants during pentavalent vaccination.

Vaccination is a quick, safe, and effective way to avoid contracting hazardous diseases, but it often causes pain and discomfort. Various pharmacological and non-pharmacological pain management techniques are used to treat pain. This study aimed to compare the effectiveness of breastfeeding, musical therapy, and oral sucrose in infant's pain relief during pentavalent vaccination. A quasi-experimental posttest-only research design was used. A total of 150 infants were enrolled using the purposive sampling technique (50 in the breastfeeding, 50 in the musical therapy, and 50 in the oral sucrose groups) coming for the first, second, and third doses of pentavalent vaccination. The data were collected using observation and the Neonatal Infant Pain Scale (NIPS). The results were calculated by descriptive and inferential statistics. The study revealed that half of the infants in the breastfeeding group felt severe pain, whereas the majority of infants in the musical therapy and oral sucrose groups felt severe pain during pentavalent vaccination. The median pain score in breastfeeding, musical therapy, and oral sucrose was 4.50, 6, and 7, respectively. Breastfeeding was significantly different from both musical therapy and oral sucrose in terms of pain scores. However, no significant difference was observed between musical therapy and oral sucrose. Overall, the results indicate that breastfeeding had a distinct impact on pain relief during pentavalent vaccination compared with the other interventions, while musical therapy and oral sucrose did not differ significantly in their effectiveness. The study concluded that breastfeeding is a safe, reliable, cost-effective, and easily accessible method to relieve an infant's pain during pentavalent vaccination. It is a simple method to alleviate pain among infants during vaccination.

Practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia, 2019

BackgroundPostoperative pain is a combined effect of several unpleasant sensory, emotional and mental experiences. Patient’s previous experiences, nature and duration of surgery, site and size of the incision and the extent of surgical trauma are some of the factors affecting the degree of post-operative pain. ObjectivesTo assess practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia. MethodInstitutional based cross-sectional study was conducted among nurses working in public referral hospitals of Amhara regional state, Ethiopia from March to April 2019. Census method was employed to select study participants. Data were entered into Epi info version 7.2.0.1 and exported to SPSS window version 20 for analysis. Binary and multivariable logistic regression was used to see the association between dependent and independent variables. The odds ratio with a 95 % confidence interval was computed. P-value < 0.05 was used to declare association. ResultsThree hundred nurses working in post-operative units of selected referral hospitals of Amhara regional state were involved in the study. The respondents’ ages (Mean ± SD.) were (29.8 ± 7.3) years and their experience (Mean ± SD) post-operative unit was (3.8 ± 3.3) years. Majority (59.7 %) of the respondents were females. This study revealed that about 50.2 % of nurses were not applied non-pharmacological post-operative pain management techniques for their patients. Nurse’s educational status, attendance of training, attitude of nurses, willingness of patients, experience in nursing, marital status and working unit were associated with practice of non-pharmacological post-operative pain management with p-value of < 0.05. ConclusionIn this study, nearly half of nurses didn’t apply non-pharmacologic pain management techniques for patients when they had pain. In-service training and educational development are recommended for nurses about non-pharmacologic pain management.

EVALUATING THE EFFICIENCY OF NON-PHARMACOLOGICAL PAIN MANAGEMENT TECHNIQUES DURING LABOR AND DELIVERY

Labor and delivery is a natural procedure that causes women significant pain and discomfort. Many women choose pharmacological pain management techniques, yet there is growing interest in non-pharmacological pain management techniques, viewed as safer and more natural than pharmacological methods. This study aimed to assess the efficacy of non-pharmacological pain management techniques during labor and delivery. In a randomized controlled trial, we randomly assigned 246 expectant women to either a non-pharmacological intervention or a control group. During labor and delivery, the non-pharmacological intervention group received a combination of relaxation techniques, including massaging and physical therapy, aromatherapy, TENS, and mixed interventions. The control group received standard care devoid of non-pharmaceutical interventions. Pain levels were measured using a visual analog scale at 30-minute intervals. Additionally, the length of labor, delivery mode, and birth outcomes were recorded using the APGAR score system. The demographic characteristics of patients in both groups were comparable and non-significant in variations (p&gt;0.05). Forty participants utilized each non-pharmacologic technique. Comparing VAS pain scale scores at 30-minute intervals, the distribution of pain intensity levels was comparable between the groups. The larger fraction of neonates in the non-pharmacological group had higher APGAR scores, indicating no need for immediate medical attention. Based on a reasonable comparison of the effectiveness of various interventions for managing labor pain and distress, it was found that 9 (22.5%) of 40 patients who received massaging therapy reported low efficacy in managing labor pain, 13 (32.5%) reported moderate efficacy, and 28 (70%) reported high efficacy. In the aromatherapy of 40 patients, 16 reported low efficacy, 21 reported moderate efficacy, and 13 reported high efficacy in managing labor pain. Ten patients (25%) reported low efficacy, 12 patients (30%) reported moderate efficacy, and 28 patients (70%) reported high efficacy in managing labor pain through TENS. It provided cost-effective and safe alternatives to pharmaceutical interventions during labor and delivery. When properly implemented, these techniques reduced pain intensity comparable to commercial medicines while significantly improving the birthing experience and potentially contributing to better maternal and neonatal outcomes.

Nurses' improved provision of infants’ procedural pain assessment and management with non-pharmacological interventions following a training program in Jordan

This study aims to compare the frequency of nurses’ documented assessment and performance of non-pharmacologic interventions to relieve procedural pain in neonates before and after a training intervention. Forty neonatal nurses received knowledge and clinical training about procedural pain assessment and non-pharmacological management related to neonates.The charts of 70–80 Neonatal Intensive Care Units admissions were compared at three-time points: once before and twice after the training intervention. Nurses’ documentation of pain assessment and non-pharmacological pain management techniques demonstrated significantly higher frequencies one month after the training than baseline (p = .00) and three months after the training than after the first month (p = .00). The training positively affected the pain management practices of nurses and clinical practice showed progressive improvement over time; all of which emphasize the importance of nurses' in-service training in improving the application of pain assessment and non-pharmacologic pain reduction strategies in NICUs.

Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review.

Perioperative pain management is a unique challenge in patients undergoing spine surgery due to the increased incidence of both pre-existing chronic pain conditions and chronic postsurgical pain. Peri-operative planning and counseling in spine surgery should involve an interdisciplinary approach that includes consideration of patient-level risk factors, as well as pharmacologic and non-pharmacologic pain management techniques. Consideration of psychological factors and patient focused education as an adjunct to these measures is paramount in developing a personalized perioperative pain management plan. Understanding the currently available body of knowledge surrounding perioperative opioid management, management of opioid use disorder, regional/neuraxial anesthetic techniques, ketamine/lidocaine infusions, non-opioid oral analgesics, and behavioral interventions can be useful in developing a comprehensive, multi-modal treatment plan among patients undergoing spine surgery. Although many of these techniques have proved efficacious in the immediate postoperative period, long-term follow-up is needed to define the impact of such approaches on persistent pain and opioid use. Future techniques involving the use of precision medicine may help identify phenotypic and physiologic characteristics that can identify patients that are most at risk of developing persistent postoperative pain after spine surgery.

The Effectiveness of Fingerhold Relaxation Techniques and Lemon Aromatherapy Towards Reducing Pain Intensity in Post Section Caesarian Patients

Aims : A person who experiences pain will have an impact on daily activities such as meeting the need for sleep, rest, and individual fulfillment as well as aspects of social interaction and, if not treated, can lead to neurogenic shock. Pain management can be done with several actions or procedures, both pharmacologically and non-pharmacologically. One of the non-pharmacological pain management techniques is the finger grip relaxation technique. This study aimed to Giving birth by Sectio Caesarea generally experiences pain due to surgical wound surgery. Design : The research design used quasy experimental with pre test-post test control group. Methods : This study conducted in November 2021. The sample in this study were all patients post Sectio Caesarea. The study samples as many as 100 people. Sampling using accidental sampling technique. Results : In the intervention group and the control group before being treated, most of them experienced moderate pain, and after being treated, most of the intervention group had mild pain, while in the control group they had moderate pain and some even experienced severe pain Conclusions : There was a difference in the average decrease in pain intensity in post-Section Caesarea patients who were given finger grip relaxation and lemon aromatherapy in the pre-intervention and post-intervention measurements in the intervention group and the control group.

Are nurses utilizing the non-pharmacological pain management techniques in surgical wards?

The non-pharmacological pain management therapies have a valuable effect in managing moderate to mild pain intensity, especially if demonstrated in the pre-operative phase. The study aimed to explore the nurses’ practice toward using non-pharmacological pain management techniques in surgical wards. In a cross-sectional research design, a convenient sample of 47 nurses in the surgical wards in Egyptian hospital (Third Level) participated in the study. Data gathered using modified Non-pharmacological Methods Questionnaire. Results of the study indicated that nurse’s perception regarding applying the cognitive-behavioral methods as a distraction and Positive reinforcement techniques were more common (68.1%,53.2%), whereas most of them used emotional support (93.6%) and preferred to demonstrate physical methods. Meanwhile, nurses addressed the barriers to apply nonpharmacological pain management as lack of time, patient unwillingness, and patients’ health beliefs. Nevertheless, nurses reported the non-pharmacological pain management is less expensive and has fewer side effects than medication and can demonstrated post-discharge. Nurses play a key role in applying effective and different non-pharmacological therapies in surgical wards. Thus, nurses should be encouraged to demonstrate the non-pharmacological pain management therapies with patients undergoing surgical procedures.

Effectiveness of Distraction Versus Cutaneous Stimulation on Venipuncture Pain Response among Children

Introduction: Intravenous procedure is invariably painful for children. Non-pharmacological techniques such as distraction and cutaneous stimulation provide coping strategies that help to manage and reduce perception of pain and decrease anxiety without medications. Aim: To compare the effectiveness of passive distraction (group I) versus cutaneous stimulation (group II) on venipuncture pain response among children. Materials and Method: A quantitative two group post-test only single centered study was conducted among 100 children, between the age group of 3 to 7 years attending a selected hospital and undergoing venipuncture at a given time. OUCHER Scale (Asian Version- Male and Female) was used to assess pain responseto compare the effectiveness of passive distraction and cutaneous stimulation aimed at decreasing pain by applying ice pack over the site of procedure. The comparison of effectiveness of interventions wascomputed by using independent‘t’ test. Results: The result showed that the mean pain score of group I (passive distraction) and group II (cutaneous stimulation) was 4.68±2.66 and 3.48±2.16, which was statistically significant (p = 0.01). There was a significant association between selected clinical aspects of children like being afraid of coming to hospital, being hospitalized and fear of needles with the pain score at p&lt; 0.05 among children received distraction technique, whereas there was no association between the selected clinical aspects of children with the pain score in group received cutaneous stimulation. Conclusion: In the present study cutaneous stimulation was found more effective pain relieve strategy than passive distraction during venipuncture.Hence, all the health care professionals should use optimal nonpharmacological pain management techniques in all aspects of paediatric practice and improve children outcomes to an extent as possible while maintaining high quality health care.

Perioperative Multimodal Pain Management: an Evidence-Based Update

The purpose of this article is to provide a concise review of recent updates and ongoing controversies in perioperative multimodal analgesia with a specific focus on systemic pharmacologic options. Acetaminophen, non-steroidal anti-inflammatory drugs, and ketamine provide clear benefit for analgesia and opioid sparing, with wide safety margins at clinically relevant doses. Enthusiasm is waning for the use of gabapentinoids (gabapentin and pregabalin) and systemic alpha-2 agonists (clonidine and dexmedetomidine) due to small benefit and a potentially dangerous side effect profile (sedation). Lidocaine infusions may improve analgesia and reduce the risk of ileus, but current research quality is poor. Corticosteroids appear to improve pain control and spare opioids but, probably at greater doses than are typically used for nausea prophylaxis. There remains limited evidence for use of anticonvulsants, antidepressants, skeletal muscle relaxants, or cannabinoids but animal studies are promising, so more clinical trials are needed in humans. There is growing evidence for the routine use of non-pharmacologic pain management techniques like transcutaneous electrical nerve stimulation and cognitive behavioral therapy. More high-quality clinical trials and systematic reviews are needed in several drug classes to assess the potential for benefit and risk of harm with respect to perioperative multimodal analgesia.

Non-pharmacological pain management in the neonatal intensive care unit: Managing neonatal pain without drugs

Premature infants hospitalized after birth are exposed to repeated painful procedures as part of their routine medical care. Early neonatal exposure to unmanaged pain has been linked to numerous negative long-term outcomes, such as the development of pain hypersensitivity, detrimental psychological symptomology, and altered neurodevelopment. These findings emphasize the crucial role of pain management in neonatal care. The aim of this article is to give an overview of evidence-based non-pharmacological pain management techniques for hospitalized neonates. Research supporting the effectiveness of various proximal, distal, and procedural pain management methods in neonates will be presented. Additionally, understanding the larger biopsychosocial context of the infant that underpins the mechanisms of these pain management methods is essential. Therefore, two important models that inform non-pharmacological approaches to infant pain management (DIAPR-R [The Development of Infant Acute Pain Responding-Revised], Attachment Theory) will be discussed.

Prévalence de la douleur en radiothérapie et amélioration de sa prise en charge

To assess pain prevalence, its features and its management in a radiotherapy department of a French public general hospital. To highlight strategies to improve pain screening and treatment. Designed in conjunction with pain management specialists, a cross-sectional study on pain was carried out. All patients treated in the department being interviewed with a standardised questionnaire during 2 days. Among 91 patients, 63.7% reported pain in daily life. They respectively represented 100%, 85.7% and 83.3% all of the patients treated for brain tumours, for bone metastasis and for head and neck cancers. Only 7.7% of patients reported pain during radiotherapy sessions. Among patients reporting pain, 70.7% received pain relief treatment and 60.8% of them thought this was adequate. While 51.6% of patients knew there was a specialist pain unit in the hospital, only 5.5% were offered a consultation with it. This unit provides non-pharmacological pain management techniques. This study confirms the importance, the underestimation and undertreatment, of pain management in radiotherapy departments. We recommend using a standardised questionnaire to identify patients at highest risk of pain, and the use of specialised pain relief teams when needed. A radiation therapist could act as a referrer to the pain relief team. Pain management remains teamwork, with links to specialised units.

Assessing the effectiveness of patient-centered nonpharmacologic pain management techniques on pain during first-trimester aspiration abortion: a randomized controlled trial

Assessing the effectiveness of patient-centered nonpharmacologic pain management techniques on pain during first-trimester aspiration abortion: a randomized controlled trial

Effect of application of ice pack on reducing pain during the arterial puncture

Background: Arterial puncture procedure is frequently performed by critical care nurses without pain management. The pain associated with arterial puncture can cause anxiety and discomfort, the evidence regarding efficiency of nonpharmacologic pain management techniques including cold application is limited and needs further researches. Objective: To investigate the effect of the local application of ice pack before procedure on reducing pain experienced by patients during the arterial puncture Materials and Methods: Quasi experimental study was undertaken among patients admitted to critical care units affiliated to Cairo University Hospital in Egypt. One hundred patients were randomly assigned to two groups. The study group (n=50) received local application of ice pack before radial arterial puncture, whereas the control group (n=50) received no intervention before radial arterial puncture. Pain immediately after the arterial puncture was scored on a visual analog scale (VAS) from 0 to 10 for both groups. Results: The immediate mean pain score after the arterial puncture were 7.36+1.34 and 7.88+0.79 for the study and control group, respectively (p<0.05). There was significant statistical difference between them (t=2.36).The mean of heart rate during the procedure were 78+11.24 b/min for the study group and 86+6.37 b/min for the control group. There was significant statistical difference between them (t=1.82, p<0.05) Conclusion: The research results showed that cold pack could be effective for relieving pain during arterial puncture. However, further researches are needed in different critical care settings and emergency units in different geographical areas to ensure generalizability of results.

Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women

Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use. Examine the determinants associated with women's use of labour pain management. Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Women aged 31-35 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%). Determinants examined included pregnancy health and maternity care [including complementary and alternative medicine (CAM)] for their most recent pregnancy and any previous pregnancies. Participants' attitudes and beliefs related to both CAM and maternity care were also included in the analysis. The outcome measures examined were the use of both pharmacological and non-pharmacological pain management techniques (NPMT). Differences were seen in the effects of demographics, health service utilization, health status, use of CAM, and attitudes and beliefs upon use of intrapartum pain management techniques across all categories. The only variable that was identified as a determinant for use of all types of pain management techniques was a previous caesarean section (CS). The effect of key determinants on women's use of pain management techniques differs significantly, and, other than CS, no one determinant is clearly influential in the use of all pain management options.

Pain Management of Children Aged 5 to 10 Years After Adenotonsillectomy

The undertreatment of pediatric pain has been widely researched and continues to be a concern for health care professionals. Adenotonsillectomy is a common pediatric surgery associated with a moderate-to-high level of postoperative pain. The purpose of this study was to increase understanding of the current pain management practices provided to children aged 5 to 10 years undergoing adenotonsillectomy and identify areas for improvement. A retrospective descriptive design was used. An extensive review of the literature on pediatric pain management after adenotonsillectomy provided the evidence to compare against the care currently provided at our institution. A retrospective chart review of 100 children who have undergone outpatient adenotonsillectomy surgery over a 6-month period was conducted. Patients who received combination opioid analgesic medications either intraoperatively or during Phase I had significantly lower pain scores in Phase II than those who received monotherapy in either setting. The combination of drug therapy and parental presence may be helpful in decreasing pain and postanesthesia care unit length of stay. Exploration of the role of nonpharmacologic pain management techniques such as distraction, guided imagery, music, and the use of ice collars in conjunction with analgesic therapy is needed.