A survey of postoperative pain treatment in children of 3–14 years

Abstract

There is a lack of information concerning the characteristics of pediatric postoperative pain in Southern European countries. The aim of this study was to document how postoperative pain in children was managed routinely at Spanish surgical wards.The study was carried out in three hospitals on the first postoperative day. Children were divided in four groups according to their age (years): Group I (3-5), II (6-8), III (9-11) and IV (12-14). The parameters evaluated were: analgesia characteristics (type of prescription, drug used and route of administration, prescribed dose and whether the drug was or was not administered, need of non-prescribed analgesics) and the postoperative pain intensity. The results were analysed using descriptive statistics. U-Mann Whitney, chi(2), ANOVA, Kruskall-Wallis and Student's t -test were also used.A total of 348 children ranging from 3 to 14 years were studied. The average age (+/- SD) was 8.2 +/- 3.3 and the majority were male (74%). Urologic surgery was the most frequent type of operation, with age (p<0.05) and hospital differences (p<0.001). The majority of the patients (52%) were prescribed an analgesic, but only 26% of them had an analgesia order at fixed dosage intervals. Differences among the hospitals were observed (p<0.001). The most commonly used analgesics were metamizol, propyphenazone, paracetamol and codeine. Differences in choice of drug in relation to age and hospital were significant (p< 0.001). Rectal was the preferred route of drug administration. Patient's age was unrelated with the prescribed analgesic dose. An average of 68% of prescriptions were given and half of the patients without scheduled analgesia needed to have analgesics administered. Around 20% of patients had high pain scores.Few paediatric patients are given analgesics at fixed dose intervals to treat postoperative pain. Pain relief therapy for children differs notably to that of adults, in respect to the drugs prescribed and the administered route. Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain.

Comparison of pain management in paediatric surgical patients in two hospitals in France and Canada

“…Numerous analgesic agents were used, and various factors contributed to the practice differences. The most frequently analgesic treatments used within 24 h after surgery in 348 patients aged 3-14 years were metamizol (31.8%), propyphenazone (30.0%), acetaminophen (20.6%), and codeine (11.8%) [8]. The three leading drugs used in 30 patients aged 0-12 years were acetaminophen (33.8%), morphine (32.3%), and acetaminophen plus codeine (26.8%) [7].…”

“…Codeine was less often used in our study, possibly because the intravenous route was the main route of administration at both hospitals. In the two previous studies, the main route of administration was per rectum (70.1%) [8] and rectal and oral routes together accounted for 67.6% of prescriptions [7]. Some children prefer using Dextropropoxyphen-Acetaminophen than Codeine-Acetaminophen, only available at RD as effervescent tablet.…”

“…Cox reported that only 1 of 27 surgical paediatric patients received fixed-schedule analgesics [7]. Banos found that over half the children received no analgesics within 24 h after surgery [8]. Recognizing the inability of young children to communicate verbally, the importance of the facial expression especially for assessing postoperative pain in children up to 18 months of age [9].…”

From the Ouchless Place to Comfort Central: The Evolution of a Concept

“…32 In newborn 33 and oncological 34 care, similar issues were identified: attitude and knowledge were fine, but practice was less so. In studies that examined children in US and Spanish hospitals, 35 Ͼ20% of the children were found to have experienced or be experiencing severe pain at the time of the survey, and only 50% were without pain. A study by Ammentorp et al 36 examined priorities of the parents of 300 hospitalized children and surveyed how satisfied they were with the attention given to those priorities.…”

Postoperative Schmerztherapie nach Tonsillektomie im Kindesalter

“…Die ora le Ap pli kati on als Trop fen be sitzt eine sehr schnelle An schlags zeit und ist des halb als Rescue-The ra pie bei Schmer zen gut ge eignet. Trotz der im mer wie der dis ku tier ten Ge fahr der Agra nu lo zy to se wird es auch im pä di at ri schen Be reich zur post ope rati ven Schmerz the ra pie ein ge setzt [4]. In ei ner dop pelblin den, ran do mi sier ten Unter su chung von Me ta mi zol mit Ibu pro fen und Pa ra ce ta mol zur Fie ber sen kung an 628 Kin dern wur de bei bes se rer Ef fek ti vität eine ver gleich ba re Ver träg lich keit gefun den [27].…”