Anesthesia| June 01 2000 Adequacy of Analgesia After Outpatient Surgery AAP Grand Rounds (2000) 3 (6): 60. https://doi.org/10.1542/gr.3-6-60 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Adequacy of Analgesia After Outpatient Surgery. AAP Grand Rounds June 2000; 3 (6): 60. https://doi.org/10.1542/gr.3-6-60 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ambulatory surgical procedures, pain management, pain Source: Munro HM, Malviya S, Lauder GR, et al. Pain relief in children following outpatient surgery. J Clin Anesth. 1999;11:187–191. This study was conducted to determine whether children undergoing outpatient surgery have adequate pain control at home. The authors prospectively collected data on 471 children at the University of Michigan Medical Center, aged 10 months to 18 years (mean 5.4+/− 4.4 years), who underwent outpatient surgical procedures expected to be associated with pain. Information about the surgical procedure, perioperative analgesia and anti-emetic administration, postoperative pain scores, and discharge prescriptions was collected. Parents were called 24 hours after the procedure and questioned about their child’s pain, analgesic and anti-emetic usage, and their ability to care for their child. The most common procedures were hernia/hydrocele repair (17%), excision of lumps/cysts (12%), adenoidectomy/adenotonsillectomy (13%), strabismus correction (9%), and orchidopexy (7%). Other procedures included orthopedic hardware removal, dental restoration, and circumcision. No cardiothoracic or neurosurgical procedures were included in the group. Four hundred and sixty parents were questioned by phone (11 patients were admitted unexpectedly after surgery) and 97% reported that their child’s analgesia was adequate or better during that first 24-hour period after surgery. The 15 (3%) children whose parents reported unacceptable analgesia were more likely to report postoperative nausea and vomiting and be difficult to care for at home. In the 185 children who received intraoperative regional analgesia for genitourinary procedures (hernia, hydrocele, orchidopexy, etc), pain relief was superior when compared to those who received only non-regional analgesia. Discharge pain scores assigned by the PACU nurses were consistent with minimal pain but 18% of parents assessed their child’s pain at discharge as moderate or severe. Acetaminophen, with or without codeine, was prescribed by the surgical service in nearly 95% of cases, while 4% did not receive a prescription. In almost one-half of the cases, the dose of acetaminophen was < 10 mg/kg PO and the codeine dose was < 1.0 mg/kg PO. Although most children in this study experienced minimal pain in the first postoperative day, from a parent’s perspective there is still room for improvement.1 Many surgeons prefer to avoid ibuprofen and aspirin because of fears that clot formation may be compromised. Therefore, pediatricians should be familiar with commonly used oral opioids. Since codeine is frequently associated with nausea and vomiting, its utility is limited, especially in the postoperative setting. Alternatives to codeine include Percocet (a combination of 5 mg oxycodone and 325 mg of acetaminophen) or PO oxycodone. Percocet dosing is generally limited by the acetaminophen dose, which should be kept below 80–90 mg/kg/24 hours. The dose for oxycodone is 0.05–0.15 mg/kg/dose up to 10 mg/dose. When prescribing opioids, it is important to keep in mind the concept of equianalgesic dosing: the relative analgesic potencies of the various opioids.3,4 When changing from one opioid to another the dose must be adjusted based on the relative potencies, different kinetics and different bioavailability. If pain control is not adequate, pediatricians should review the analgesic... You do not currently have access to this content.