Postoperative symptoms at home following day-case surgery in children: a multicentre survey of 551 children.

The incidence and duration of postoperative symptoms in children at home following day-case anaesthesia and surgery was evaluated using a questionnaire completed by parents of 551 children aged 4 months to 13.4 years (mean 3.8 years). They also evaluated the instructions given in hospital for care at home. The incidence of all symptoms was highest at home on the day of the operation. No postoperative symptoms were reported in 79 (14%) children. The incidence of pain was 56% and the only significant predictor was the type of operation, tonsillectomy being the most problematic (mild pain in 38% and severe in 25%; pain lasted 7 days or longer in 33%). Analgesics were given to 78% of all the children reported to have pain on the day of the operation, to 60% the next day and later to 58%; 19 (3%) children were given more than two doses per day. The instructions given in hospital for the treatment of pain were considered inadequated by 12% of parents. Postoperative nausea and vomiting occurred in 13% of children. Predictors by multiple stepwise logistic regression analysis were emetic symptoms in hospital, pain at home, age > 5 years and administration of postoperative opioid (pethidine or fentanyl). Opioid given during anaesthesia (fentanyl or alfentanil) did not increase the incidence. Emetic symptoms were most common after tonsillectomy (31%). The highest incidences of emetic symptoms (37%), sedation (96%) and dizziness (41%) occurred in children who had been given fentanyl for postoperative pain. Undertreatment of nausea in hospital was evident as only two children had received anti-emetics, even though 61 were reported to have emetic symptoms. Administration of effective anti-emetics should be encouraged, as emetic symptoms in hospital were the most significant predictor of nausea and vomiting at home. Treatment of pain at home and instructions for treatment of pain need to be improved.

The problem of post-spinal headache.

Headache is the most common complication of spinal anaesthesia. Although it is usually harmless it can, however, be so distressing to the patient that the fear of this unpredictable drawback may make many anaesthetists reluctant to use this simple anaesthetic technique. Although it is difficult to predict which patients will get post-spinal headache (PSH), we fortunately know some groups of patients who are more susceptible to PSH than others. They include young patients, female patients, patients with a history of travel sickness, patients with previous PSH, patients with an asthenic constitution and patients who have a minor operation with prompt discharge. The use of a thin needle (25-26 G) reduces the occurrence of PSH. Hydration during the operation day does not prevent PSH, nor does recumbency of 24 hours. The results are contradictory when a prophylactic epidural blood patch is used to prevent PSH. Although PSH usually ceases spontaneously within 1-4 days, treatment with an epidural blood patch is indicated if PSH is severe or affects the time of discharge. The presence of this complication must be recognised, should be avoided as far as possible and treated when necessary, but it certainly does not prevent the use of spinal anaesthesia.