Purpose: To explore the difficulties of measuring and analyzing pain in children at home after ambulatory surgery (AS). Conceptual framework: Prescriptive theory of acute pain management in infant and children. Sample: This analysis includes 75 children (ages 7-12 years) from a previously-reported RCT on guided imagery. There were no significant differences in postoperative outcomes measured in the home between groups, therefore findings represent both groups. Method: The children, with the help of their parent(s), were asked to keep a structured diary for the first 24 hours after discharge from AS. The diary included amount of fluids ingested, level of pain measured with Oucher and Faces instruments, and the amount of analgesics used as well as other non-pharmacologic pain relief interventions. Results: Despite instructions to assess pain every four hours, parents were inconsistent in intervals between pain assessments; which prohibited an averaging or repeated measures analysis of pain levels. In measuring pain, the use of analgesics must be considered and controlled statistically. Because this was a multiple site study, different pain medications were prescribed. Parents also used acetaminophen or ibuprofen at home. The opioids were converted to morphine equivalents; however there is no equivalency for non-opioids in the literature. Analyzing the non-opioids separately may produce intolerable levels of missing data. Those children receiving hydrocodone received significantly less than recommended doses, while acetaminophen with codeine was given in adequate doses. All children over 50 kg received lower doses than recommended. Conclusion: In planning research that measures pain in children at home, consistency of medications and adequate teaching of protocol to the caregiver is needed. Parents’ beliefs about pain may influence the frequency of assessment and the administration of analgesics. Assessing pain at regular intervals or at a randomized timing may give a more accurate assessment of children’s pain at home.
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Session #1223 - Graduate Student Poster Session
The 29th Annual MNRS Research Conference (April 1-4, 2005)