Are children given insufficient pain‐relieving medication postoperatively?

Abstract

The literature often suggests and assumes that children are under-medicated postoperatively. A review of the literature leads to the conclusion that only a few studies answer the question of whether children's pain is relieved insufficiently. The lack of consensus on expected pain intensity after surgery and caution about prescribing analgesics could explain why analgesics are often prescribed on a pro re nata (prn) basis. Prescription on a prn basis, in fact, means that the nurse makes the decision whether or not an analgesic should be administered. Some studies suggest, however, that nurses under-medicate children and that postoperative pain is relieved insufficiently. In some situations, nurses under-estimate the child's pain, while in others, nurses' attitudes, beliefs and knowledge regarding pain relief strategies play an important role. On the basis of this review of the literature standard prescription of pain medication instead of prn is recommended. Furthermore, research on the incidence and prevalence of pain in children and on the effectiveness of analgesic administration postoperatively is warranted.

Pre-surgical child behavior ratings and pain management after two different techniques of tonsil surgery

“…In spite of the maximal doses prescribed to both TT/TE children in the present study, only a mean of about 60% of paracetamol and diclophenac were given during the first 24 h. Paracetamol and diclophenac were to be ''administered at regular intervals'' following standard prescription, and not on a pro re nata (prn) basis as recommended by Hamers et al [10]. There was also an ordination of morphine i.v.…”

“…The experience and attitudes of the observer/ nurses are important [10,30], but the patient/ child's experience of pain is subjective and his/ her experience has to be regarded as the correct one. Therefore, the scoring of a lower pain level by staff than by children and parents must be a real underestimation that might have resulted in inadequate pain management.…”

“…The post-operative pain is poorly managed [4,5], and under-treatment of pain leads to increased morbidity as well as post-operative behavioral changes [4][5][6][7][8][9]. Several investigators have tried to explain insufficient post-operative pain medication with difficulties for the nurses to assess children's pain and resulting in prescription of analgesics in doses that are too low [10][11][12].…”

Perianesthesia Nurses’ Pain Management After Tonsillectomy and Adenoidectomy: Pediatric Patient Outcomes

“…These data support the need for pain medication titration and validate that the amount required to relieve pain differs from child to child. 5,6,8 A common side effect of all opioids is nausea and vomiting. Unfortunately, almost 30% of the patients had nausea or vomiting, which is consistent with the literature for patients after T&A.…”

“…6 Pain researchers have traditionally concluded that children are routinely undermedicated for pain when they receive less analgesic than ordered. 7,8 Additional research is warranted to determine if commonly prescribed analgesics can be administered by postanesthesia nurses to effectively relieve pain and improve patient outcomes after T&A.…”