Wilson Margaret E, Helgadóttir Helga L
College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska 68198-5330, USA.
Pain Manag Nurs. 2006 Dec;7(4):159-66. doi: 10.1016/j.pmn.2006.09.005.
Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Although self-report is the gold standard for pain assessment, researchers have not studied young children at home with self-report measures. The purpose of this study was to describe the patterns of self-reported pain intensity and analgesic administration in 3- to 7-year-old children undergoing tonsillectomy during the operative day in the hospital and the first 2 postoperative days at home in Iceland. As part of a larger study, 68 children undergoing tonsillectomy were taught to use the Wong-Baker FACES Pain Rating Scale. Pain intensity scores and data about administration of analgesics were collected from children, the medical record, and the parents over a 3-day period. Children received primarily acetaminophen or acetaminophen with codeine in the hospital. At home, 99% of doses administered were acetaminophen only. Most doses were administered rectally. Forty percent of children received 24-hour therapeutic doses in the hospital. Only 10% received a 24-hour therapeutic dose at home despite significant pain scores of 4 or 5 persisting through the second postoperative day. Younger children were less likely to receive acetaminophen with codeine. In the hospital, children with pain intensity scores of 4 or 5 received prescribed morphine only 13% of the time. Children experienced clinically significant pain through the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.
扁桃体切除术是一种常见的外科手术，通常伴随着中度至重度疼痛。虽然自我报告是疼痛评估的金标准，但研究人员尚未使用自我报告方法对在家中的幼儿进行研究。本研究的目的是描述冰岛3至7岁接受扁桃体切除术的儿童在医院手术当天以及术后在家的头两天自我报告的疼痛强度和镇痛药物使用模式。作为一项更大规模研究的一部分，68名接受扁桃体切除术的儿童被教导使用面部表情疼痛评分量表（Wong-Baker FACES Pain Rating Scale）。在三天的时间里，从儿童、病历和家长那里收集了疼痛强度评分以及有关镇痛药物使用的数据。儿童在医院主要接受对乙酰氨基酚或含可待因的对乙酰氨基酚。在家中，99%的给药剂量仅为对乙酰氨基酚。大多数剂量通过直肠给药。40%的儿童在医院接受了24小时治疗剂量。尽管术后第二天疼痛评分仍高达4或5，但只有10%的儿童在家中接受了24小时治疗剂量。年龄较小的儿童不太可能接受含可待因的对乙酰氨基酚。在医院，疼痛强度评分为4或5的儿童仅13%的时间接受了处方吗啡。儿童在术后第二天仍经历具有临床意义的疼痛，可能需要改变方案以便更早地提供更积极的疼痛管理。这项研究将当前疼痛管理方案不足的研究证据扩展到了年龄更小的儿童。
