Two-thirds of low-income Latino children given inadequate pain control post-surgery at home
Roundup of news from presentations at Anesthesiology 2014 meeting
More than two-thirds of children from low-income Latino families don’t receive adequate pain control when they go home after surgery, according to a study presented at the Anesthesiology 2014 annual meeting.
Researchers studied 139 Latino families with children who had surgery to remove their tonsils or adenoids. All children had surgery at one hospital, and each family’s total income was $30,000 or less per year. Spanish-speaking researchers visited the families at home 2-7 days after surgery, and they asked parents and children to assess the child’s pain. Seventy percent of parents and children reported the child had significant pain on the first day after surgery.
To control postoperative pain, it is recommended children receive 12 to 18 doses of pain medication during the first three days after surgery. The study found that, on average, parents administered only seven doses during the first three days. Thirty percent of the children received only one dose of pain medication or none at all the first day after they got home.
Researchers also interviewed parents about the child’s experience in the hospital and home. Four themes emerged:
- lack of knowledge about pain management, including concerns that the child might become addicted or be harmed by the medication;
- a preference for alternative medicine such as herbal remedies;
- poor communication or lack of time spent with healthcare providers, which left concerns and questions unaddressed;
- barriers within the healthcare system such as a lack of translators and inadequate insurance In other research news from the Anesthesiology 2014 meeting:
Gum chewing before surgery.
Although chewing gum significantly increases the volume of liquids in the stomach, it is safe to administer sedatives or anesthesia to patients who have chewed gum while fasting before surgery, reports a new study.
"We found that although chewing gum before surgery increases the production of saliva and thus the volume of stomach liquids, it does not affect the level of stomach acidity in a way that would elevate the risk of complications," says Basavana Goudra, MD, lead author and assistant professor of clinical anesthesiology and critical care at Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Impact of silence and jazz during recovery on heart rates and pain.
Patients undergoing elective hysterectomies who listened to jazz music during their recovery experienced significantly lower heart rates, suggests a study presented. But the research also found that patients who wore noise-cancelling headphones also had lower heart rates, as well as less pain.
"We need to determine what kind of music works best, when we should play it, and when silence is best," says Flower Austin, DO, anesthesiology resident at Penn State Milton S. Hershey Medical Center, Hershey, PA, and lead study author. "But it’s clear that music as well as silence are cost effective, non-invasive, and may increase patient satisfaction."
Anesthesia-related complications decrease significantly.
Anesthesia-related complications decreased by more than half in four years, according to the Anesthesia Quality Institute’s (AQI) National Anesthesia Clinical Outcomes Registry (NACOR) of more than 3.2 million anesthesia cases. While the overall mortality rate held steady between 2010 and 2013 (at .03%), the percentage of adverse events related to anesthesia decreased from 11.8% to 4.8% of procedures during that time period. The most common minor complication was postoperative nausea and vomiting (35.53%), while the most common major complication was medication error (11.71%).
Researchers also determined that: minor complications were more common in healthier patients undergoing elective daytime procedures; complication rates were not higher in procedures that occurred during evening hours and holidays; and patients older than 50 had the highest rates of serious adverse events.
