Lee Jaclyn, Delaney Katherine, Napier Molly, Card Elizabeth, Lipscomb Brittany, Werkhaven Jay, Whigham Amy S, Franklin Andrew D, Bruehl Stephen, Stone Amanda L
Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Children (Basel). 2020 Nov 19;7(11):236. doi: 10.3390/children7110236.
Parental attitudes regarding pain interventions and perceptions of their child's pain intensity likely influence the decision to administer postoperative analgesics. Our study examined the impact of daily fluctuations in child pain intensity and parental attitudes regarding complementary and alternative medicine (CAM) on analgesic administration following pediatric tonsillectomy. Parents of children undergoing tonsillectomy (n = 33) completed a survey assessing CAM attitudes and a 7-day postoperative electronic daily diary to record their child's daily pain intensity and analgesic medications (acetaminophen, ibuprofen, or oxycodone). Generalized linear mixed models with Poisson distributions evaluated the effects of within-person (child's daily pain intensity) and between-person (average postoperative pain, parental CAM attitudes) components on the number of medication doses administered. Higher daily pain intensity was associated with more oxycodone doses administered on a given day, but not acetaminophen or ibuprofen. Positive parental CAM attitudes were associated with less oxycodone use, beyond the variations accounted for by the child's daily pain intensity and average postoperative pain. Both parental CAM attitudes and their child's daily pain intensity were independently associated with parental decisions to administer opioids following tonsillectomy. Understanding factors influencing individual variability in analgesic use could help optimize children's postoperative pain management.
父母对疼痛干预措施的态度以及对其孩子疼痛强度的认知可能会影响术后镇痛药的给药决策。我们的研究考察了儿童疼痛强度的每日波动以及父母对补充和替代医学（CAM）的态度对小儿扁桃体切除术后镇痛药物给药的影响。接受扁桃体切除术的儿童的父母（n = 33）完成了一项评估CAM态度的调查以及一份术后7天的电子每日日记，以记录其孩子的每日疼痛强度和镇痛药物（对乙酰氨基酚、布洛芬或羟考酮）。采用泊松分布的广义线性混合模型评估个体内（孩子的每日疼痛强度）和个体间（术后平均疼痛、父母对CAM的态度）因素对给药剂量数量的影响。每日疼痛强度较高与特定日期使用更多的羟考酮剂量相关，但与对乙酰氨基酚或布洛芬无关。父母对CAM的积极态度与较少使用羟考酮相关，这超出了孩子每日疼痛强度和术后平均疼痛所解释的变异。父母对CAM的态度及其孩子的每日疼痛强度均与扁桃体切除术后父母给予阿片类药物的决策独立相关。了解影响镇痛药物使用个体差异的因素有助于优化儿童术后疼痛管理。
