Factors influencing postoperative pain following discharge in pediatric ambulatory surgery patients

Abstract

Study objective: To identify demographic, intraoperative, and parental factors that influence the postoperative pain experience in ambulatory surgery pediatric patients. We also monitored postoperative maladaptive behavior changes (PMBCs) to investigate the relationship between pain and PMBCs.

Design: Prospective cohort study.

Setting: Discharge period after ambulatory surgery.

Patients: 204 patients ages 1-6years undergoing ambulatory orthopedic, urology, general surgery, and otolaryngology surgical procedures who were American Society of Anesthesiologists (ASA) physical status I or II.

Interventions: None.

Measurements: We administered telephone questionnaires to parents of ambulatory surgery patients 1-6years old exploring pain ratings, behavior change ratings, and medication compliance at 2-3days and 1-2weeks after surgery. Pain and behavioral change scores were obtained using the Parents Postoperative Pain Measure (PPPM) and Post-Hospital Behavior Questionnaire (PHBQ). Parental medication compliance was defined as parents who followed the discharge instructions for pain medication administration.

Main results: For our cohort, 69% of patients experienced pain after 2-3days and 17% after 1-2weeks post-discharge. PMBCs were reported in 55% after 2-3days, and in 15% after 1-2weeks. In addition, PMBCs occurred in the absence of pain (PPPM=0) at rates of 20% and 5% at 2-3days and 1-2weeks after surgery, respectively. Female sex, anesthesia duration, and otolaryngology procedures correlated with higher postoperative pain (PPPM) scores in univariate and multivariate analysis. Intraoperative medications did not correlate with PPPM or PHBQ scores. Higher pain scores were associated with parents who were compliant with discharge instructions for pain medications.

Conclusions: Many pediatric patients experienced short-term pain and PMBCs after ambulatory surgery, but these largely resolved by 1-2weeks following discharge. Patient sex, anesthesia duration, and surgical procedure influenced postoperative pain and/or PMBCs. Furthermore, PMBCs were associated with, but not solely a manifestation of, postoperative pain.

Keywords: Pain medications; Pediatric ambulatory surgery; Pediatric postoperative pain; Postoperative maladaptive behavior.