Does take‐home analgesia improve postoperative pain after elective day case surgery? A comparison of hospital vs parent‐supplied analgesia

Hegarty, Mary; Calder, Alyson; Davies, Kylie; Shave, Margaret; Christiansen, Elaine; Meyer, Tessa; Ungern‐Sternberg, Britta S. von

doi:10.1111/pan.12077

Cited by 28 publications

(22 citation statements)

References 13 publications

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“…Despite available analgesics, few doses were administered to children postoperatively. Interestingly, the recently published randomized-controlled study by Hegarty et al 42 found the prevalence of moderate-to-severe postoperative pain to be 41% in the group that was prescribed analgesics compared to 38% in the group that was prescribed and supplied analgesics at discharge. There appeared to be no difference in the incidence of pain between the 2 groups.…”

Section: Parental Satisfaction With Use Of Pain Assessment Toolmentioning

confidence: 99%

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Postoperative Pain in Children After Dentistry Under General Anesthesia

Wong

Copp

Haas

2015

Anesthesia Progress

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The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P , .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rho s correlation coefficients of 0.604 and 0.603, P , .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.

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Section: Parental Satisfaction With Use Of Pain Assessment Toolmentioning

confidence: 99%

“…There appeared to be no difference in the incidence of pain between the 2 groups. While parents were able to use the Wong-Baker Faces Scale and PPPM at home, Hegarty et al 42 determined only 48% of parents recalled advice pertaining to analgesia.…”

Section: Parental Satisfaction With Use Of Pain Assessment Toolmentioning

confidence: 99%

Postoperative Pain in Children After Dentistry Under General Anesthesia

Wong

Copp

Haas

2015

Anesthesia Progress

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“…A major component of patient satisfaction is postoperative pain control. [3][4][5][6][7][8]12,16,17 Regional anesthesia is an important tool that allows patients to undergo a surgical procedure with a greatly reduced amount of opioid pain medications. In addition, regional anesthesia can provide significant pain control after the patient has left the ambulatory surgery center, but this relief is short-lived because the medication is designed to lose effectiveness over time.…”

Section: Discussionmentioning

confidence: 99%

Multi-Modal Pain Control in Ambulatory Hand Surgery

Harrison¹,

DiMeo²,

Klinefelter³

et al. 2018

Am J Orthop

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We evaluated postoperative pain control and narcotic usage after thumb carpometacarpal (CMC) arthroplasty or open reduction and internal fixation (ORIF) of the distal radius in patients given opiates with or without other non-opiate medication using a specific dosing regimen. A prospective, randomized study of 79 patients undergoing elective CMC arthroplasty or ORIF of the distal radius evaluated postoperative pain in the first 5 postoperative days. Patients were divided into 4 groups: Group 1, oxycodone and acetaminophen PRN; Group 2, oxycodone and acetaminophen with specific dosing; Group 3, oxycodone, acetaminophen, and OxyContin with specific dosing; and Group 4, oxycodone, acetaminophen, and ketorolac with specific dosing. During the first 5 postoperative days, we recorded pain levels according to a numeric pain scale, opioid usage, and complications. Although differences in our data did not reach statistical significance, overall pain scores, opioid usage, and complication rates were less prevalent in the oxycodone, acetaminophen, and ketorolac group. Postoperative pain following ambulatory hand and wrist surgery under regional anesthesia was more effectively controlled with fewer complications using a combination of oxycodone, acetaminophen, and ketorolac with a specific dosing regimen.

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“…The intervention resulted in significant reductions in activity limitations (mean difference 2.74, p=0.004) and pain reductions (mean difference 1.17, p=0.03) compared to wait list control. In an RCT addressing postoperative pain, Hegarty and colleagues found administering take-home analgesic drugs did not statistically significantly influence pain, analgesic drug administration, nausea, vomiting or sleep when compared with parent supplied analgesic drugs (Hegarty et al, 2013).…”

Section: Descriptive Summarymentioning

confidence: 99%

An Integrative Review of Interventions to Support Parents When Managing Their Child's Pain at Home

Parker

McKeever

Wiseman

et al. 2018

Pain Management Nursing

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To identify interventions aimed at helping parents manage their child's pain at home and to establish which aspects of interventions were effective. Integrative narrative review. MEDLINE, CINAHL Plus, PsychINFO, PsychArticles, AMED, PubMed, Scopus and Web of Knowledge databases were searched in 2016. This narrative synthesis followed Centre for Reviews and Dissemination and Economic and Social Research Council guidance. Reasons attributed to intervention success were analyzed using content analysis. From 2,534 papers, 17 were included. A majority were randomized controlled trials (n = 13) and most addressed postoperative pain (n = 15). A range of interventions were found that directly targeted parents, including child-parent interactions and health care professional-parent interactions, as well as complex interventions. Three studies were successful in reducing child pain at home and seven in increasing appropriate analgesic drug administration. Analysis of reasons attributed to interventions success revealed characteristics of interventions, components of parental pain management, and key features of research that aid researchers in designing and evaluating interventions. Risk of bias was present because of inadequate randomization, lack of a control group, and underpowered studies. Nurses should be aware that targeting parents directly is the most effective way of reducing child pain at home. Nurses need to advocate for effective analgesics for their child patients because the ineffectiveness of many interventions was attributed to inadequate analgesic drugs. Once this is achieved, success in increasing analgesic drug administration is most likely reached via parent-targeted interventions and those targeting health care professional-parent interactions. Successful interventions will be tailored to the child and adequately powered. Including a measure of sedation will ensure sedation is not mistaken for analgesic effectiveness. Interventions should address multiple facets of pain management and include a measure of pain over a period as opposed to a snapshot in time.

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Does take‐home analgesia improve postoperative pain after elective day case surgery? A comparison of hospital vs parent‐supplied analgesia

Abstract: Our study did not show any differences in the incidence of pain/parental satisfaction between the two groups. Analgesia advice given to parents was poorly retained, suggesting that other methods for disseminating information should be considered.

Cited by 28 publications

References 13 publications

Postoperative Pain in Children After Dentistry Under General Anesthesia

Postoperative Pain in Children After Dentistry Under General Anesthesia

Multi-Modal Pain Control in Ambulatory Hand Surgery

An Integrative Review of Interventions to Support Parents When Managing Their Child's Pain at Home

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