Pain prevalence and pain management in children and adolescents in an italian third level pediatric hospital: a cross-sectional study

Abstract

Background In 2016, we performed a one-day investigation to analyze the prevalence of pain, pain intensity, and pain therapy in the Departments of Surgery and Onco-Hematology of the Ospedale Pediatrico Bambino Gesù. To improve the knowledge gap highlighted in the previous study, refresher courses and even personalized audits have been carried out during these years. The purpose of this study is to evaluate if, after 5 years, there have been improvements in the management of pain. Methods The study was conducted on 25 January 2020. Pain assessment, pain therapies, pain prevalence and intensity in the preceding 24 h and during the recovery period were recorded. Pain outcomes were compared with previous audit results. Results Out of the 63 children with at least one documented pain assessment (starting from 100 eligible), 35 (55.4%) experienced pain: 32 children (50.7%) experienced moderate /severe pain while 3 patients (4%) felt mild pain. In the preceding 24 h, 20 patients (31.7%) reported moderate/severe pain while 10 (16%) reported moderate or severe pain during the interview. The average value of the Pain Management Index (PMI) was − 1.3 ± 0.9 with a minimum of -3 and a maximum of 0. 28 patients (87%) undergoing analgesic therapy for moderate/severe pain had a PMI of less than 0 (undertreated pain), while 3 patients (13%) scored value of 0 or higher (adequate pain therapy), 4 patients (12.5%) received multimodal analgesia with opioids and 2 patients (6%) opioids alone. Time-based therapy was prescribed to 20 patients (62.5%), intermittent therapy was prescribed to 7 patients (22%) and 5 patients (15.5%) did not receive any therapy. The prevalence of pain was higher during hospitalization and 24 h before the interview, while at the time of the interview, the proportion was the same. In this audit, the daily prescription modality of the therapy had some improvements (time-based: 62.5% vs. 44%; intermittent: 22%vs 25%; no therapy: 15.5% vs. 31%). Conclusion Pain management in hospitalized children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain. Trial registration : This study is registered with ClinicalTrials.gov, number (NCT04209764), registered 24 December 2019, https://clinicaltrials.gov/ct2/show/NCT04209764?term=NCT04209764&draw=2&rank=1.

Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study

“…Another interesting point is that even if pain is the most important factor in unplanned admission, and pain is often undertreated in pediatrics (Marchetti et al 2023 ), in our experience, no patients were admitted for pain (Awad et al 2004 ; Shapiro et al 2014b ). Probably, the combination of locoregional anesthesia and mini-invasive surgical incisions reduced pain substantially (Lerman 2019 ).…”

Application of an ultrasound-guided bilateral erector spinae plane block after the Nuss procedure for pectus excavatum in children: a retrospective cohort study with propensity score matching

“…Analgesic therapy in children is largely single agent and intermittent, although very helpful when given (13). The pain experienced by children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain and to measure and implement strategies that prevent the dysfunction that causes pain (14). Therapeutic anesthesia generally includes patient-controlled intravenous analgesia, TEA, paravertebral block (PVB), a subcutaneous catheter for infusion, and cryoanalgesia (15)(16)(17)(18).…”

Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies

“…The profound anxiety experienced by children during surgery can exert substantial and enduring effects on their physical and psychological health. It is noteworthy that nearly 20% of children might encounter stress-induced negative behavioral changes following surgery, resulting in impediments to timely recovery and challenges in self-care [ 47 ]. Furthermore, preoperative anxiety has been linked to heightened postoperative pain and escalated utilization of analgesics [ 48 ].…”