Quality assessment of postoperative pain management in pediatric surgical patients.

Objective: To evaluate the incidence of moderate to severe pain in children during 24 hours following surgery, including their risk factors, analgesic treatment and complications. Methods: A retrospective descriptive study was conducted at a university hospital from 1 March 2003 to 28 February 2004. Children aged 1-15 years, ASA 1-2, who underwent major operation at the Department of Surgery were recruited into the study. Postoperative pain was assessed by age-appropriated scales at least 10 times in the first 24 hours postoperatively. Their demographic data, type of operation, anesthetic technique, medication and complication were recorded. Results: Two hundred and thirty children, median age of 8 years (IQR 4-11 years) were recruited. They received surgical operations on various regions of the bodies, namely: groin/perineum, head/neck/face, extremity and abdomen/trunk with the following percentages: 24.3%, 10.9%, 3.5 % and 59.1%, respectively. Incidents of moderate to severe pain in the first 24 hours occurred in 100 patients (43.5 %). Their risk factors included age > 6 years old (adjusted OR 2.21) and inadequacy of analgesic treatment (adjusted OR 38.80). Pethidine IV and oral paracetamol on PRN basis were commonly prescribed with too long dosing interval. The common postoperative complication identified was nausea and vomiting (19.6%). No respiratory depression was detected. Conclusion: Postoperative pain in children was still under-treated. More attention should be provided to children > 6 years old. Proper prescription of analgesic dosing interval, frequent assessment and appropriate criteria for treatment on PRN basis tended to reduce pain.

Comparison of morphine given by an intravenous sliding scale or by intramuscular route for postoperative pain relief in pediatric patients: An interim analysis.

Objective: To assess the efficacy in pain relief, complication, practicality and patient’s compliance of morphine given by IV sliding scale (IV) compared to that given intramuscularly (IM) in children after surgery. Methods: One hundred and third-two children were randomly allocated to receive postoperative morphine via IM route (0.1 mg/kg) on a 6-h PRN basis or IV route on a sliding scale basis. Blood pressure, heart rate, respiratory rate, SaO2, nausea/vomiting, pain score using CHEOPS and patient’s compliance were recorded. A questionnaire was used to evaluate the satisfaction with and practicality of these techniques among nurses. Results: This study was terminated early and interim analysis was performed because 47% of the patients in the IM group refused treatment and only 32 patients remained for study (age 1.9-12y, ASA 1). The proportions of patients with moderate to severe pain (IM 73.3%, IV 76.5%), median of maximum CHEOPS score (IM 9, IV 10), average CHEOPS score (IM 6.01, IV 6.03), and morphine consumption (IM 0.157,IV 0.144 mg/kg/24h) of both groups were not statistically different. Neither respiratory depression nor desaturation was detected. Nurses preferred using the sliding scale technique due to better patient’s compliance. Conclusion: The IV sliding scale was superior to IM technique regarding patient’s compliance and nurses’ preference. The degree of pain relief obtained and complications of treatment were not different.

Management pattern and hospital charge of repairing cleft palate at Siriraj Hospital.

Management pattern and hospital charge for repairing cleft palate at Siriraj Hospital during 1996-1999 were studied retrospectively. From the examination of 100 patient records, four cases were excluded since no surgical correction was performed during hospitalization. Fifty-nine percent were female and the average age was 5.54 years old. Fever and otitis media were associated with two and three cases respectively. Other underlying diseases included hypothyroidism, patent ductus arteriosus and ventricular septal defect were found one in each case. The cleft palate was successfully repaired in all cases. Surgical correction was done in 84 percent of cases within the first five days of hospitalization. The average length of stay was 5.89 + 2.85 days and ranged from 2-20 days. The hospital charge for cleft palate repair was 7,031.22 + 1,365.33 Baht per case. This study illustrate that a small variation is practiced in the management of a reasonably straight forward condition and better preparation of the patients before hospitalization could reduce the hospital stay or avoid unnecessary hospitalization.