Pain Control After Outpatient Surgery in Children
Source: Kokinsky E, et al. Postoperative comfort in paediatric outpatient surgery. Paediatr Anaesth 1999;9:243-251.
One-day, outpatient surgery is becoming increasingly common for a variety of surgical conditions. Children are usually observed in a one-day-care surgical unit until they have recovered from the immediate effects of anesthesia and are stable. They are then sent home with medications to control discomfort. Kokinsky and associates evaluated postoperative conditions in hospital and after going home in 200 children who had one-day outpatient surgical procedures using questionnaires and telephone interviews. Depending upon the patient’s age, pain was assessed by behavior observation or a fates rating schedule. Anesthetic methods, events of nausea and vomiting, and use of analgesics were also recorded. Seventy percent of the children had received regional anesthesia that was often supplemented by intravenous sedation. Immediate post-operative analgesia was judged to be satisfactory in 75% of children. However, when the effects of intra-operatively administered analgesics wore off at home, nearly half of the children complained of pain rated higher than mild. The increased pain was especially pronounced after regional anesthesia. Twenty-eight percent of children experienced nausea and vomiting, and this was higher in children who received fentanyl.
This study indicates that immediate postoperative comfort obtained by prophylactic analgesia needs to be followed by continuing effective analgesia for the first days after surgery. The pediatrician should be certain that the surgeon or anesthesiologist is cognizant of the need to prescribe appropriate pain medications, and that the family understands the schedule for administering these medications. It goes without saying that they should be certain that the prescriptions can be filled in time for indicated administration. —hap