Parents' Postoperative Pain Measure Research Articles

A Double-Blinded Randomized Controlled Trial Assessing the Efficacy of Opioid Disposal Instructions with Parental Education on Proper Opioid Disposal Rates Following Ambulatory Pediatric Urologic Surgery

ObjectivesTo determine if the administration of standardized opioid disposal instructions with focused parental education improves proper disposal of leftover opioid medication among families of children undergoing ambulatory urologic surgery compared to routine postoperative instructions. MethodsA prospective, double-blinded, single-center randomized controlled trial was conducted in children 6-18y undergoing ambulatory urology procedures between October 2021-April 2023. Patients were randomized (1:1) to receive either the Food and Drug Administration (FDA) opioid disposal best practices worksheet plus nursing parental education or routine postoperative instructions alone. All patients were prescribed acetaminophen and ibuprofen and a per-protocol rescue opioid prescription. The primary outcome was rate of proper opioid disposal at 10-14d post-procedure. Secondary outcomes included parents postoperative pain measure (PPPM) scores, numerical pain scale (NPS) scores, and weight-based opioid utilization at 48h and 10-14d. ResultsWe randomized 104 participants (53 intervention, 51 control) with 97% (101/104) complete follow-up data at 10-14d. Patient demographics, procedural characteristics, and analgesia use were similar between groups. We observed no significant difference in proper opioid disposal rates between arms (31% intervention vs. 18% control; estimated difference in proportion 13% [95% CI, -4–29%]; p=0.1). There was no increased odds of proper disposal of leftover opioid medication at 10-14d with the intervention compared to the control (OR 2.0 [95% CI 0.8–5.1]; p=0.1). We observed no differences in PPPM scores, NPS scores, or opioid utilization at 48h or 10-14d. ConclusionsProviding formal opioid disposal instructions with parental education did not improve proper disposal of leftover opioid medication nor did it alter post-discharge opioid utilization after pediatric urologic surgery.

Reliability and validity of the Dutch version of the Parents’ Postoperative Pain Measure (PPPM-Dv)

Background: Pain is often poorly managed in pediatric daycare surgery. The Parents’ Postoperative Pain Measure (PPPM) is available as parent report to rate children’s pain at home after surgery and is a reliable and well validated tool. Objectives: To establish the reliability and validity of the Dutch version of the Parents’ Postoperative Pain Measure (PPPM-Dv) to assess postoperative pain among children aged between 2 and 12 years during five postoperative days at home. Design: cross-sectional cohort study. Setting: ZNA Queen Paola’s Children’s Hospital. Methods: 120 children were included. Stratification was done according to age (2-5 and 6-12 years) and three surgical categories. Parents socioeconomic status (SES) and religion were registered. For all children, parents recorded pain using the PPPM-Dv and Numerical Rating Scale (NRS-11) twice daily for five days. Children between 6-12 years were asked to rate their experienced pain using the Faces Pain Scale-Revised (FPS-R). Results: From 120 children included 91 (76.6%) families completed pain diaries. Reliability across the five-day postoperative period, Cronbach’s α for PPPM-Dv was .70 to .90. Correlations between PPPM-Dv and NRS- 11/FPS-R were strong (.81 and .61). Using NRS-11(≥4) as binary classifier (yes/no), ROC analysis identified a PPPM-Dv score >2 as cut-off, with a sensitivity of 89% and specificity of 82%. With FPS-R (≥4) as binary classifier (yes/no), ROC analysis identified a PPPM-Dv score >2 as cut-off (sensitivity:88%; specificity:79%). PPPM-Dv scores decreased over time and followed a similar pattern as the NRS-11 and FPS-R scores. Generalized Estimation Equations (GEE) showed that higher PPPM-Dv scores were associated with a more painful surgical category and were independent of SES and religious affiliation. Conclusion: These data provide evidence for the reliability and validity of the PPPM-Dv. This can be a helpful tool to identify pain in children after daycare surgery at home in a Dutch speaking population. Trial registration: https://doi.org/10.1186/ISRCTN12813822

MP18-09 LIPOSOMAL BUPIVACAINE PLUS BUPIVACAINE VS. BUPIVACAINE ALONE IN PEDIATRIC PATIENTS UNDERGOING UROLOGIC SURGERY: PRELIMINARY REPORT FROM THE BABY ORIOLES TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP18-09 LIPOSOMAL BUPIVACAINE PLUS BUPIVACAINE VS. BUPIVACAINE ALONE IN PEDIATRIC PATIENTS UNDERGOING UROLOGIC SURGERY: PRELIMINARY REPORT FROM THE BABY ORIOLES TRIAL Andrew Gabrielson, Tamir Sholklapper, Chad Crigger, Logan Galansky, Kelly Harris, Hiten PATEL, Nora Haney, Ming-Hsien Wang, Charlotte Wu, John Gearhart, and Heather Di Carlo Andrew GabrielsonAndrew Gabrielson More articles by this author , Tamir SholklapperTamir Sholklapper More articles by this author , Chad CriggerChad Crigger More articles by this author , Logan GalanskyLogan Galansky More articles by this author , Kelly HarrisKelly Harris More articles by this author , Hiten PATELHiten PATEL More articles by this author , Nora HaneyNora Haney More articles by this author , Ming-Hsien WangMing-Hsien Wang More articles by this author , Charlotte WuCharlotte Wu More articles by this author , John GearhartJohn Gearhart More articles by this author , and Heather Di CarloHeather Di Carlo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Long-acting liposomal bupivacaine (Exparel) was approved for children >6 years old however it has not been evaluated in children undergoing urologic surgery. We report preliminary safety and efficacy data of Exparel plus bupivacaine vs. bupivacaine alone for incisional infiltration or penile block in pediatric patients undergoing ambulatory urologic surgery as part of a randomized trial. METHODS: The study is an IRB-approved prospective, single-blinded trial randomizing patients 6-18 years old 1:1 to receive Exparel plus 0.25% bupivacaine (experimental) vs. 0.25% bupivacaine alone (control) during ambulatory urology procedures (NCT04826484). Patients received Tylenol and Ibuprofen prescriptions and a rescue prescription of 3-5 doses 0.1 mg/kg Oxycodone. Efficacy endpoints include percent requiring no opioids within 48hr and 10-14d, parents’ postoperative pain measure (PPPM) scores at 48hr and 10-14d, and oral morphine equivalents (OMEQ) per kg given through 10-14d. RESULTS: A total of 52 patients (29 control, 23 experimental) have been enrolled. Demographic, procedural, efficacy, and safety data are summarized in Table 1. There was no difference in percentage of patients requiring no post-operative opioids through 48hr (57% vs 55%, p=0.92). There was no difference in mean FLACC score in PACU (0.9 vs 1.2, p=0.64), PPPM score at 48hr (2.5 vs. 3.5, p=0.09) or PPPM score at 10-14d (0.55 vs. 0.6, p=0.67). The experimental arm had significantly reduced OMEQ/kg at 10-14d (0.06 vs. 0.2, p=0.02). However, OMEQ/kg utilization was low and limited to the 48hr post-op period in both arms. There were no intraoperative complications and similar use of perioperative Ketorlac between arms. Roughly 10% of patients in both arms had an unplanned phone call or message to the office (all related to swelling). No patients had unplanned presentation to the emergency department. CONCLUSIONS: This prospective, single-blinded randomized trial is the first to evaluate Exparel in pediatric patients undergoing urologic surgery. We demonstrate that albeit safe, the addition of Exparel to 0.25% bupivacaine did not improve validated pain scores or opioid-free rate at 48 hours. Formal assessment of efficacy and safety pending trial accrual. Source of Funding: Internally funded © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e226 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Gabrielson More articles by this author Tamir Sholklapper More articles by this author Chad Crigger More articles by this author Logan Galansky More articles by this author Kelly Harris More articles by this author Hiten PATEL More articles by this author Nora Haney More articles by this author Ming-Hsien Wang More articles by this author Charlotte Wu More articles by this author John Gearhart More articles by this author Heather Di Carlo More articles by this author Expand All Advertisement PDF downloadLoading ...

Postoperative recovery in children: Turkish cross-cultural adaptation.

Postoperative recovery is an individual process involving subjective experiences. The fact that children still experience high rates of complications associated with surgery requires the discovery of new evaluation methods. No studies in Turkey have reported a measurement instrument evaluating postoperative recovery in children. The purpose of this methodological study is to cross-culturally adapt the Postoperative Recovery in Children (PRiC) instrument into the Turkish language and test the validity and reliability of its Turkish version. One hundred children (81% male) aged 4 to 12 years undergoing tonsillectomy at a hospital were included. The self-administered PRiC and Parents' Postoperative Pain Measure (PPPM) instruments were used to collect data on the 1st, 4th, and 10th days after surgery. Internal consistency, parallel-forms reliability, content validity, and construct validity of the instruments were determined. PRiC had a three-factor structure, and these factors explained 68% of the total variance in the variable it measured. It showed a high level of internal consistency (Cronbach's alpha=0.842). The item-total score correlation coefficients for 23 of the items were ≥0.30. PRiC was moderately correlated with PPPM on the 1st day after surgery (r=0.64, p < .01), on the 4th day after surgery (r=0.69, p < .01), and on the 10th day after surgery (r=0.51, p < .01). The Turkish version of PRiC has good reliability and validity. A validity and reliability study of PRiC to assess children's postoperative recovery in the context of different surgical operations should be conducted.

Comparison of short-term recovery in children with obstructive sleep apnea undergoing tonsillotomy vs. tonsillectomy.

To compare the pain levels, degrees of pharyngeal swelling, and weight loss after tonsillectomy vs. tonsillotomy in children clinically diagnosed with obstructive sleep apnea (OSA) over the first seven postoperative days, and to determine which procedure was associated with better recovery in the early postoperative period. Between April 2021 and December 2021, 121 children with OSA (80 males and 41 females), ranging from 3 to 12 years of age with an average age of 6.7 years, were prospectively enrolled in this study conducted at Zhengzhou Central Hospital Affiliated to Zhengzhou University. The patients were randomly divided into two groups: a tonsillotomy group with 63 cases (40 males and 23 females) and a tonsillectomy group with 58 cases (40 males and 18 females). The patients' pain levels [as indicated by Parents' Postoperative Pain Measure (PPPM) scores] and degrees of pharyngeal swelling were recorded for seven days postoperatively, and the patients' body weights were recorded on postoperative day seven. In the tonsillotomy group, the PPPM scores were the highest on the day of surgery and on the first postoperative day; the patients' pain levels gradually decreased.The PPPM scores in the tonsillectomy group were higher than those in the tonsillotomy group from the day of surgery to the seventh postoperative day (p < 0.05). The degree of pharyngeal swelling was lower in the tonsillotomy group than in the tonsillectomy group. Weight loss was lower in the tonsillotomy group than in tonsillectomy group on the 7th day after surgery (p < 0.05). On the fifth, sixth, and seventh postoperative days, compared with preschool children, school-age children who had undergone tonsillotomy experienced more pain relief than those who had undergone tonsillectomy (p < 0.05). Children with OSA experienced less pain, less pharyngeal swelling, and less weight loss with tonsillotomy than with tonsillectomy. On the fifth, sixth, and seventh postoperative days, compared with preschool children, tonsillotomy in school-age children is more advantageous in school-age children.

MP47-02 ELIMINATING OPIOIDS IN OUTPATIENT PEDIATRIC SURGERY

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-02 ELIMINATING OPIOIDS IN OUTPATIENT PEDIATRIC SURGERY Matthew Sims, Paige Hargis, and Elizabeth Malm-Buatsi Matthew SimsMatthew Sims More articles by this author , Paige HargisPaige Hargis More articles by this author , and Elizabeth Malm-BuatsiElizabeth Malm-Buatsi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In recent years, use of opioid prescriptions has undergone increasing scrutiny worldwide. In the pediatric urology population, there has been limited research on decreasing post-operative opioid prescriptions, but no studies utilize a zero-opioid approach. We recently performed a retrospective study of 242 patients at our institution, in which no patient received opioids at discharge. Only 2.1% called about post-op pain. In this prospective study, we aim to assess eliminating opioids in postoperative pain control as part of a multimodal approach in pediatric patients undergoing same-day urologic surgery. METHODS: After IRB approval was obtained, patients aged 6 months to 12 years-old undergoing common outpatient urologic procedures were treated with a multimodal approach for post-op pain management that did not include narcotics. This did involve comprehensive parent education, intra-operative local anesthesia, ice packs, bacitracin ointment for penile cases, and acetaminophen and ibuprofen prescriptions at discharge. Parents were contacted on post-op day (POD) 2 and POD7 to inquire about the child’s pain and parent satisfaction. To assess pain, we used validated pain surveys: Parents’ Post-operative Pain Measure (PPPM) for children over 2 years and the Face-Legs-Activity-Cry-Consolability (FLACC) for children under 2 years. Parent satisfaction regarding pain control, prescription practices, and expectations was evaluated with a Likert scale. RESULTS: 120 patients were included in the study from March to November 2020. We received responses from parents of 95 patients (79.2% response rate). On POD2, 6/95 (6.3%) patients had clinically significant pain, as determined by responses to PPPM or FLACC. 7 days after surgery, 2/92 (2.2%) reported clinically significant pain. However, those two patients had pain not directly related to the surgical site: a diaper rash in one patient and the other patient with urethral pain from accidental catheter pull. None of our patients ever required narcotic pain medications. Average parent satisfaction with pain control was 4.86/5.0. CONCLUSIONS: We found that post-op pain in pediatric patients undergoing outpatient urologic surgery can be successfully managed without opioid pain medication and with excellent parent satisfaction. This is the first study of its kind to assess zero-opioid prescribing in this patient population and should give pediatric urologic surgeons the confidence needed to forego narcotics in these patients. This approach is successful when coupled with a comprehensive parent education, expectation management, and multi-modal therapy. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e823-e823 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Sims More articles by this author Paige Hargis More articles by this author Elizabeth Malm-Buatsi More articles by this author Expand All Advertisement Loading ...

Randomized Controlled Trial of Scrotal versus Inguinal Orchidopexy on Postoperative Pain.

To compare the impact of orchidopexy approach (scrotal vs inguinal) on analgesic requirements, postoperative pain scores and complication rates. A superiority randomized controlled trial including boys 10 to 95 months of age at surgery, diagnosed with palpable undescended testis, was conducted. Patients with nonpalpable or bilateral undescended testis, previous inguinal surgery on the ipsilateral side and concurrent procedures were excluded. Block randomization with 1:1 allocation ratio and a standardized anesthesia protocol were employed. The primary outcome was postoperative pain and analgesic use in-hospital and at home using the validated pain scales FLACC (Face, Legs, Activity, Cry, and Consolability Behavioural Scale), CHEOPS (Children's Hospital of Eastern Ontario Pain Scale), PPPM (Parents Postoperative Pain Measure) and TPPPS (Toddler-Preschooler Postoperative Pain Scale). Secondary outcomes included operative time, conversion and success rates, and complications. An intention to treat protocol was followed. We enrolled 173 patients, and 12 withdrew. Of the 161 patients who completed followup, 80 had scrotal orchidopexy and 81 inguinal orchidopexy. In-hospital use of ibuprofen (p=0.02) and acetaminophen (p <0.01), as well as FLACC (p <0.01) and CHEOPS (p=0.04) pain scores were slightly higher in patients who underwent orchidopexy. No difference in mean operative time and median at-home administration of analgesic was noted. The conversion rate was 24% (19/80). Of these, 13 (68%) were canalicular testes. The overall complication rate was 4% (6/161): 1 testicular atrophy, 3 re-ascents and 2 wound infections. Of these, 5 underwent scrotal orchidopexy and 1 had inguinal orchidopexy (wound infection). Even though in-hospital mean postoperative pain scores and analgesic consumption were slightly lower for scrotal orchidopexy cases, the pain levels were mild across all scales. Median at-home analgesic use and pain scores were similar for both groups, as well as operative time and complication rates. Scrotal orchidopexy is an effective alternative to inguinal orchidopexy for low-lying undescended testis, as 68% of cases that needed conversion were canalicular testes.

Postoperative pain course after paediatric tonsillectomy: A prospective observational study comparing one behavioural and one numerical pain assessment tool

IntroductionPaediatric tonsillectomy is often performed as outpatient surgery, although postoperative pain may be severe and protracted. This prospective observational study evaluated two paediatric pain assessment tools for use in telephone interviews with parents. MethodsASA I-II children, ≥1 and < 13 years, undergoing outpatient tonsillectomy were recruited. Anaesthesia (propofol-remifentanil) and intraoperative analgesia were standardized. Sedating premedication was not given.Before discharge, a “smiley face” numerical pain assessment tool was introduced to parents. In telephone interviews on postoperative days 1, 3, 7 and 14, parents scored their childrens pain numerically (0–10) and on the behavioural Postoperative Pain Measure for Parents (PPMP, 0-15). Number of analgesic doses (paracetamol/ibuprofen) per 24 h was noted. Values are median (quartiles). Results22 consecutive children were included, age 4 (3–6) years. Parents had administered analgesics to 100%, 95%, 80%, and 5% of children at the four interview times. Numerical pain scores were 3.5 (1–7) at hospital discharge, and 5.5 (3–7), 3 (2–6), 3.5 (0–6), and 0 (0-0) on postoperative days 1, 3, 7, and 14, respectively. In 12/22 children, pain declined to a value of 1 (0–2) on day 7. In 6/22 children pain initially declined, but surged to 5.5 (4–7) on day 7. Significant, protracted pain (9 (6–10) on day 7) was reported in 3/22 children. Behavioural (PPMP) scores were positively correlated to numerical pain scores (day 3: R2 = 0.48, day 7: R2 = 0.31, day 14: R2 = 0.85). With increasing age, children systematically had lower behavioural pain scores for the same numerical pain score (0.61 per years age; p < 0.023). ConclusionIn structured telephone interviews, parents effectively pain scored their children after outpatient tonsillectomy. Numerical and behavioural pain scores correlated well, however age-dependent. Pain courses varied considerably, and a majority of children had significant pain. Pain after paediatric tonsillectomy should be assessed and treatment individualised.

Comparison of Postoperative Pain and Appetite in Pediatric Patients Undergoing Monopolar Tonsillotomy and Cold Steel Tonsillectomy.

Objectives Adenotonsillectomy (AT) is amongst the most widely performed pediatric surgeries in the United States (US) and the whole world. AT includes two major surgical techniques: total tonsillectomy (TT) and partial tonsillectomy (PT). Several studies have been conducted to evaluate the difference between TT and PT and assess the comparative effectiveness, benefits, and sequelae between both. In Lebanon, very few studies were done tackling this issue and assessing its sequelae on the pediatric population. Methods A prospective study was conducted including pediatric patients aged between 2 and 9 years, who were admitted for partial tonsillectomy (PT) or total tonsillectomy (TT) in 2018. An estimated number of children included were 50: 25 patients underwent PT and 25 patients underwent TT. Patients were sent home on day 1 post-op with a questionnaire that evaluates the following over the first 10 days post-op: pain using the Wong–Baker Faces Pain Rating Scale and the “Parents Postoperative Pain Measure” (PPPM) questionnaire, and appetite using the visual analogue scale (VAS). Results Patients in the PT group and in the TT group had no demographical differences in terms of age, BMI, exposure to smoking, area of living, and attending a day care center. Comparison between PT and TT revealed a significant difference in both pain and appetite scales. Patients who underwent PT had significantly lower PPPM scores on the 1st, 2nd, 4th, 5th, 6th, and 10th day after surgery compared to the TT patients. Further validation was revealed by the Wong–Baker Faces Pain Rating Scale, showing that the PT surgery group experienced significantly less postoperative pain compared to the TT surgery group. Assessing the appetite using the visual analogue scale favored PT over TT. Comparisons revealed that most PT patients returned to their normal eating habits starting at day 4 while this was applicable in the TT group at day 10. Postoperative pain improved from day 1 to day 10 in both surgical groups. Conclusion In conclusion, the recovery process after the PT surgery causes less postoperative morbidity, thus an earlier return to normal activity compared to the TT. The patients of the latter group are affected by more pain and less appetite over the first 10 days after the surgery.

Systemic Lidocaine Infusion for Post-Operative Analgesia in Children Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Double-Blind Controlled Trial.

Systemic lidocaine can provide satisfactory post-operative analgesia in adults. In this study, we assessed whether intravenous lidocaine is effective for post-operative analgesia and recovery in children undergoing laparoscopic inguinal hernia repair. A total of 66 children aged from six months to less than six years were classified in either the lidocaine (L) or control (C) groups. Children in Group L received a lidocaine infusion (a bolus dose of 1 mL kg−1, followed by a 1.5 mg kg−1 h−1 infusion), whereas Group C received the same volume of 0.9% saline. The primary outcome was the number of patients who presented face, legs, activity, crying and consolability (FLACC) scores of four or more, and therefore received rescue analgesia in the post-anesthesia recovery care unit (PACU). Secondary outcomes included the highest FLACC score in the PACU, FLACC, and the parents’ postoperative pain measure (PPPM) score at 48 h post-operation, as well as side effects. The number of children who received rescue analgesia in the PACU was 15 (50%) in Group L and 22 (73%) in Group C (p = 0.063). However, the highest FLACC score in PACU was lower in Group L (3.8 ± 2.4) than in Group C (5.3 ± 2.7) (p = 0.029). In conclusion, systemic lidocaine did not reduce the number of children who received rescue analgesia in PACU.

Differences in postoperative maladaptive behavioral changes between partial and total tonsillectomy patients

IntroductionBehavioral difficulties associated with sleep-disordered breathing (SDB) improve after tonsillectomy, but surgery may lead to the development of short-term postoperative maladaptive behavioral changes (PMBCs). These PMBCs have not been compared between total and partial tonsillectomy patients. MethodsSDB patients aged 1–6 years undergoing tonsillectomy were recruited. Parent phone surveys were conducted at 48–72 hours and 1–2 weeks postoperatively. Parents identified PMBCs using the Post-Hospital Behavior Questionnaire (PHBQ), scoring changes in behavior compared to baseline. PMBCs were defined by PHBQ scores >0 and compared by one-tailed t-test. Postoperative pain was categorized as mild, moderate, and severe pain using the Parents' Postoperative Pain Measure (PPPM). Differences in pain levels were analyzed by Chi-squared test. A p-value <0.05 was deemed statistically significant. ResultsSeventy-eight children completed the study, with 29 total tonsillectomy and 49 partial tonsillectomy patients. At both time points after surgery, PHBQ scores were higher in total tonsillectomy patients than in partial tonsillectomy patients (3.41 ± 3.53 versus 1.94 ± 2.25 at 2–3 days, p = .013). PMBCs were also more frequent in total than partial tonsillectomy patients (76% versus 59% at 2–3 days; 28% versus 7% at 1–2 weeks). Meanwhile, distribution of pain levels was similar between both partial and total tonsillectomy patients. ConclusionsOur study indicates that total tonsillectomy patients more frequently experience PMBCs than do partial tonsillectomy patients despite similar distributions in pain levels postoperatively. This difference in PHBQ scores between total and partial tonsillectomy patients should be further explored.

Factors influencing postoperative pain following discharge in pediatric ambulatory surgery patients

Study objectiveTo identify demographic, intraoperative, and parental factors that influence the postoperative pain experience in ambulatory surgery pediatric patients. We also monitored postoperative maladaptive behavior changes (PMBCs) to investigate the relationship between pain and PMBCs. DesignProspective cohort study. SettingDischarge period after ambulatory surgery. Patients204 patients ages 1–6years undergoing ambulatory orthopedic, urology, general surgery, and otolaryngology surgical procedures who were American Society of Anesthesiologists (ASA) physical status I or II. InterventionsNone. MeasurementsWe administered telephone questionnaires to parents of ambulatory surgery patients 1–6years old exploring pain ratings, behavior change ratings, and medication compliance at 2–3days and 1–2weeks after surgery. Pain and behavioral change scores were obtained using the Parents Postoperative Pain Measure (PPPM) and Post-Hospital Behavior Questionnaire (PHBQ). Parental medication compliance was defined as parents who followed the discharge instructions for pain medication administration. Main resultsFor our cohort, 69% of patients experienced pain after 2–3days and 17% after 1–2weeks post-discharge. PMBCs were reported in 55% after 2–3days, and in 15% after 1–2weeks. In addition, PMBCs occurred in the absence of pain (PPPM=0) at rates of 20% and 5% at 2–3days and 1–2weeks after surgery, respectively. Female sex, anesthesia duration, and otolaryngology procedures correlated with higher postoperative pain (PPPM) scores in univariate and multivariate analysis. Intraoperative medications did not correlate with PPPM or PHBQ scores. Higher pain scores were associated with parents who were compliant with discharge instructions for pain medications. ConclusionsMany pediatric patients experienced short-term pain and PMBCs after ambulatory surgery, but these largely resolved by 1–2weeks following discharge. Patient sex, anesthesia duration, and surgical procedure influenced postoperative pain and/or PMBCs. Furthermore, PMBCs were associated with, but not solely a manifestation of, postoperative pain.

Postoperative Pain in Children After Dentistry Under General Anesthesia.

The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.

Magnesium as an adjuvant for caudal analgesia in children.

There is a need for an adjuvant agent of caudal block that prolongs its duration and improves the analgesic efficacy to fasten functional recovery. Magnesium is an N-methyl-D-aspartate receptor antagonist that functions as an analgesic. This study was aimed to evaluate whether magnesium as an adjuvant for caudal block in children can improve postoperative analgesia and functional recovery. Eighty children, 2-6 years of age, undergoing inguinal herniorrhaphy, were included in this prospective, randomized, double-blinded study. For caudal block, Group R received ropivacaine 1.5 mg·ml(-1), 1 ml·kg(-1) and Group RM received the same dose of ropivacaine mixed with 50 mg of magnesium. The Parents' Postoperative Pain Measure (PPPM) score, analgesic consumption, functional recovery, and adverse effects were evaluated at 6, 24, 48, and 72 h after surgery, as well as daily thereafter until the child showed full functional recovery. The PPPM score after hospital discharge was significantly lower for Group RM than for Group R at all times (P < 0.05). Children in Group RM required less fentanyl for rescue analgesia in the recovery area (16.2% vs 39.5%, P = 0.034) and less oral analgesics after discharge (20.5% vs 52.6%, P = 0.007). The time to return of normal functional activity was shorter in Group RM (P < 0.05). The incidence of adverse effects did not differ between groups. As an adjuvant for caudal analgesia, 50 mg magnesium provided superior quality of analgesia and faster return of normal functional activity than local anesthetic alone in children.

Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children

Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting. A prospective cohort study was performed including 167 children aged 0-12 years, undergoing AD using an adenotome and ATE using the guillotine technique in day care. Children undergoing AD received acetaminophen pre- and postoperatively. Children undergoing ATE received acetaminophen and diclofenac preoperatively, sufentanyl postoperative and a prescription of around-the-clock treatment with acetaminophen and diclofenac at home. Pain intensity and analgesic consumption were recorded in hospital using the Faces, Legs, Activity, Cry and Consolability-scale (FLACC), as well as during a 1-week follow-up period at home using the Parents' Postoperative Pain Measure (PPPM) and Visual Analogue Scale (VAS) scores. All children left the recovery room with adequate pain scores and were discharged with a median VAS of two after ATE and one after AD. The PPPM and VAS scores were highest at the first measurement at home for AD patients (VAS = 2.0 and PPPM = 1.5) and ATE patients (VAS = 4.5 and PPPM = 9). On the second postoperative day, AD patients scored 0.0 points on both VAS and PPPM. ATE patients scored at that time 3.0 point on the VAS and 6.0 points using the PPPM. Despite high adherence to pain treatment, daytime activities normalized after an average of 2 and 7 days after AD and ATE, respectively. Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.

Clinical utility of PPPM and FPS-R to quantify post-tonsillectomy pain in children

ObjectivesAs pain is a subjective and difficult parameter to assess in children, we aimed to evaluate the correspondence of two pain scales – parents’ post-operative pain measure (PPPM) and faces pain scale-revised (FPS-R) with analgesic intake in the assessment of post-tonsillectomy pain in a pediatric population. MethodsChildren aged 4–10 years (n=174) undergoing tonsillectomy with or without adenoidectomy had their pain monitored by PPPM and FPS-R over 7 days following surgery. The amount of analgesic (acetaminophen or dipyrone) intake was also recorded each day. Linear regression and correlation analysis were performed for pain scales and Poisson regression model for analgesic administration. To evaluate influence of gender linear regression and logistic regression with random effects were performed. ResultsPPPM and FPS-R presented a significant positive correlation (τ=0.5; R2=0.36; p<0.001). PPPM and FPS-R also showed a significant correlation with analgesic use over the 7 post-operative days (p<0.0001). No influence of gender was observed in pain levels by both scales. ConclusionsOur data demonstrate that PPPM and FPS-R are equivalent pain scales to quantify post-tonsillectomy pain in children and are useful tools in post-tonsillectomy clinical research.

Effect of Dexamethasone on Nausea, Vomiting, and Pain in Paediatric Tonsillectomy

Hermans, V.*; De Pooter, F.*; De Groote, F.*; De Hert, S.†; Van Der Linden, P.* Author Information

Ethnicity and parental report of postoperative behavioral changes in children

To examine the role of ethnicity and language in parent report of children's postoperative behavioral recovery. To compare incidence of new onset negative behavior change in English- and Spanish-speaking White and Hispanic children following outpatient surgery. Postoperative behavioral change in children is common; however, it is unknown whether cultural variables including ethnicity and language may influence parent report of children's behavioral recovery. Participants included 288 parents (English-speaking White, English-speaking Hispanic, Spanish-speaking Hispanic parents) of children undergoing outpatient elective surgery. Parents completed the post-hospitalization behavior questionnaire (PHBQ) and parents' postoperative pain measure (PPPM) on postoperative days one, three, and seven at home. Most parents (83%) reported onset of new negative behavioral change in children postoperatively. Generalized estimating equations revealed significant group differences in overall behavior change [Wald χ(2)(12) = 375.69, P < 0.0001] after controlling for demographic and socioeconomic differences. At all three postoperative days, Spanish-speaking Hispanic (SSH) parents reported lower negative behavioral changes in their children compared to English-speaking White (ESW) parents (day 1: P < 0.01; day 3: P < 0.001; day 7: P < 0.10). On postoperative days one and three, SSH parents also reported lower total PHBQ scores than English-speaking Hispanic (ESH) parents [day 1: χ(2)(1) = 6.72, P = 0.01; day 3: χ(2)(1) = 7.98, P = 0.005]. The present study provides evidence that parent report of children's postoperative behavioral recovery may be influenced by cultural variables, such as ethnicity and language. The present results contribute to a growing body of evidence that highlights the need for culturally sensitive assessment and care of families in the medical setting. The findings may reflect differences in cultural values such as stoicism; however, future studies would benefit from examination of the factors that may account for the differences in reported behavior change after surgery (i.e., report bias, cultural values).

Translating the tears: parents' use of behavioural cues to detect pain in normally developing young children with everyday minor illnesses or injuries

The objectives of this paper were to (i) identify the behavioural cues used by parents to detect young children's transient pain from minor illnesses or injuries ('everyday pain'); and (ii) perform an initial psychometric evaluation of the Parents' Post-operative Pain Measure (PPPM) in the context of children's everyday pain. Cross-sectional Internet survey. One thousand seven hundred sixteen parents of children (1-6 years) completed the survey. The parents reported more behaviours when children had pain from minor illnesses than from minor injuries (9.6 ± 3.9 vs. 2.5 ± 2.3, P < 0.001). Principal component analysis of the PPPM revealed a two-factor solution for illness-related pain and a three-factor solution for injury-related pain. Behavioural cues varied with characteristics of children (age, gender and prior hospital experience) and parents (gender, age and parenting experience). The PPPM is a promising tool for parental assessment of children's pain in everyday situations. Further research is needed to determine its utility in facilitating communication between parents and healthcare professionals, and in improving the management of young children's pain.

The parents’ postoperative pain measure: replication and extension to 2–6-year-old children

Pain assessment is a difficult task for parents at home following children's surgery. The purpose of the present study was to confirm the psychometric properties of a behavioural measure of postoperative pain developed to assist parents with pain assessment in children aged 7–12 years following day surgery. The study also examined the reliability and validity of the measure with children aged 2–6 years. Participants were 51 parents of children aged 7–12 years and 107 parents of children aged 2–6 years. For the 2 days following surgery, parents completed a pain diary that included global ratings of their children's pain and the 15-item Parents’ Postoperative Pain Measure (PPPM). The older children provided self-reports of their pain intensity. The PPPM items showed good internal consistency on the two postoperative days for both samples (α’s=0.81–0.88) and scores on the PPPM were highly correlated with children's (for the older children) and parents’ (for the young children) global ratings of pain ( r's=0.53–0.72). As global pain ratings decreased from Days 1 to 2, so did scores on the PPPM. Scores on the PPPM were successful in discriminating between children who had undergone low/moderate and high pain surgeries. The results of this study provide evidence of the reliability and validity of the PPPM as a measure of postoperative pain among children aged 2 through to 12 years.