Walther-Larsen Søren, Aagaard Gitte Bruun, Friis Susanne Molin, Petersen Trine, Møller-Sonnergaard Jørn, Rømsing Janne
Pediatric Pain Service, Department of Anesthesiology, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Pharmaceutics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Paediatr Anaesth. 2016 Feb;26(2):151-7. doi: 10.1111/pan.12811. Epub 2015 Nov 12.
Ambulatory surgery forms a large part of pediatric surgical practice. Several studies indicate that postoperative pain is poorly managed with more than 30% of children having moderate to severe pain. In a busy outpatient clinic contact between healthcare professionals and the family is increasingly limited calling for a global and efficient pain management regime.
The aim of this prospective observational cohort study was to determine postoperative pain intensity following day surgery in children after our structured intervention for pain management.
A number of interventions in an effort to address barriers to effective postoperative pain management after day surgery were identified in the literature. By introducing our concept structured intervention, we aimed to address the majority if not all these barriers. Accordingly, we adapted postoperative pain management to each child using a multimodal approach consisting of surgery-specific analgesia with weight appropriate doses of acetaminophen and ibuprofen. Analgesics were handed out to the parents in formulations accepted by child and parent and after thorough information to the parents.
Two hundred and forty-five children were scheduled for surgery during the 3-month period of which 149 children were available for analysis. The postoperative pain as assessed by the parents with a the Short Form of the Parents' Postoperative Pain Measure (PPPM-SF) was well managed exhibiting a median pain score of 4 on postoperative day 0 (POD0) and median 1 on postoperative day 1 (POD1) and a numeric rating scale (NRS) median pain score of 2 on POD0 and median 1 on POD1. We found a highly significant correlation between the PPPM-SF and the NRS scores.
After thorough information of the parents we have successfully implemented a surgery-specific regime of primarily around-the-clock dosing of drug formulations acceptable for the specific child with dispensed medication ready available for the family.
门诊手术在小儿外科手术中占很大比例。多项研究表明，术后疼痛管理不善，超过30%的儿童有中度至重度疼痛。在繁忙的门诊诊所，医护人员与家庭之间的接触越来越有限，这就需要一种全面且高效的疼痛管理方案。
这项前瞻性观察队列研究的目的是确定在我们针对疼痛管理的结构化干预后，儿童日间手术后的术后疼痛强度。
在文献中确定了一些旨在解决日间手术后有效术后疼痛管理障碍的干预措施。通过引入我们的概念性结构化干预，我们旨在解决大部分（如果不是全部）这些障碍。因此，我们采用多模式方法，根据每个孩子的情况调整术后疼痛管理，包括使用适合体重剂量的对乙酰氨基酚和布洛芬进行特定手术的镇痛。镇痛药以儿童和家长都能接受的剂型分发给家长，并在向家长进行充分告知后发放。
在3个月期间，有245名儿童安排进行手术，其中149名儿童可供分析。家长使用简化版家长术后疼痛测量量表（PPPM-SF）评估的术后疼痛得到了良好管理，术后第0天（POD0）的疼痛评分中位数为4，术后第1天（POD1）为1，数字评分量表（NRS）在POD0时的疼痛评分中位数为2，在POD1时为1。我们发现PPPM-SF和NRS评分之间存在高度显著的相关性。
在向家长进行充分告知后，我们成功实施了一种针对特定手术的方案，主要是为特定儿童按昼夜给药，提供可供家庭随时使用的药物剂型。
