Rede Fassil Mihretu, Goshu Eyayalem Melese, Muzien Sulaiman Jemal
Wollo University, College of Medicine and Health Sciences, Department of Anesthesia, Dessie.
Addis Ababa University, College of Health Sciences, Department of Anesthesia, Addis Ababa, Ethiopia.
Ann Med Surg (Lond). 2024 Jan 17;86(3):1275-1282. doi: 10.1097/MS9.0000000000001742. eCollection 2024 Mar.
Postoperative pain is a common and distressing consequence of surgery in children. It can lead to suffering, prolonged recovery, impaired physical functioning, and even chronic pain. Effective postoperative pain management is crucial for improving patient outcomes. However, several factors hinder the accurate assessment and management of pain in children, particularly in low-income countries. This study aims to evaluate the severity of postoperative pain in paediatric patients and identify its predictors.
A longitudinal study was conducted on 235 paediatric surgical patients aged 2 months-7 years in Public Hospitals of Addis Ababa from January to April 2023. The primary outcome, pain severity, was assessed at three different times using a pain assessment tool. Cochran's q-test was used to compare postoperative pain incidences. The Generalized Estimating Equation was used to determine predictor variables' effects on pain severity over time. The study demonstrated the direction of association and significance using an AOR with a 95% CI at a value of 0.05.
The incidence of moderate to severe postoperative pain was 36.6% at 12 h, 20% at 24 h, and 10% at 36 h. Patients with preoperative pain and preoperative anxiety were more likely to experience moderate to severe postoperative pain [adjusted odds ratio (AOR)=3.41, CI=1.15, 10.00 and AOR=2.28, CI=1.219, 4.277, respectively). Intraoperative predictors of postoperative pain severity included longer duration of surgery (AOR=6.62, CI=1.90, 23.00) and major surgery (AOR=5.2, CI=2.11, 12.88). Postoperative pain severity was reduced in patients receiving multimodal analgesia (AOR=0.24; CI=0.091, 0.652) and in patients assessed frequently in the postoperative period (AOR=0.09; CI=0.022, 0.393).
A significant portion of paediatric surgical patients in this study experienced high levels of postoperative pain, particularly within the first 24 h. The most influential factors affecting pain severity were postoperative pain management strategies and assessment practices.
术后疼痛是儿童手术常见且令人痛苦的后果。它会导致患儿遭受痛苦、恢复时间延长、身体功能受损，甚至引发慢性疼痛。有效的术后疼痛管理对于改善患者预后至关重要。然而，有几个因素阻碍了对儿童疼痛的准确评估和管理，尤其是在低收入国家。本研究旨在评估儿科患者术后疼痛的严重程度并确定其预测因素。
2023年1月至4月，在亚的斯亚贝巴的公立医院对235名年龄在2个月至7岁的儿科手术患者进行了一项纵向研究。使用疼痛评估工具在三个不同时间点评估主要结局指标——疼痛严重程度。采用 Cochr an's q检验比较术后疼痛发生率。使用广义估计方程来确定预测变量随时间对疼痛严重程度的影响。该研究使用比值比（AOR）及95%置信区间（CI）在α值为0.05的情况下展示关联方向和显著性。
术后12小时中度至重度疼痛的发生率为36.6%，24小时为20%，36小时为10%。术前有疼痛和术前焦虑的患者更有可能经历中度至重度术后疼痛[调整后比值比（AOR）分别为3.41，CI = 1.15，10.00和AOR = 2.28，CI = 1.219，4.277]。术后疼痛严重程度的术中预测因素包括手术时间较长（AOR = 6.62，CI = 1.90，23.00）和大手术（AOR = 5.2，CI = 2.11，12.88）。接受多模式镇痛的患者（AOR = 0.24；CI = 0.091，0.652）以及术后频繁接受评估的患者（AOR = 0.09；CI = 0.022，0.393）术后疼痛严重程度降低。
本研究中相当一部分儿科手术患者经历了高水平的术后疼痛，尤其是在术后最初24小时内。影响疼痛严重程度的最主要因素是术后疼痛管理策略和评估方法。
