Document Type
Article
Publication Date
5-2-2019
Abstract
Objective
The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration.
Methods
This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain).
Results
A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1–3 (30.05%–35.95%). Of those pairs in disagreement, the majority of parents overestimated their child's pain on all three postoperative days, specifically such that a total of 24–26% parents overestimated their child's pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents.
Conclusions
Since parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.
Recommended Citation
Kaminsky, O., Fortier, M. A., Jenkins, B. N., Stevenson, R. S., Gold, J. I., Zuk, J., Golianu, B., Kaplan, S. H., & Kain, Z. N. (2019). Children and their parents’ assessment of postoperative surgical pain: Agree or disagree? International Journal of Pediatric Otorhinolaryngology, 123, 84–92. https://doi.org/10.1016/j.ijporl.2019.04.005
Copyright
Elsevier
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Included in
Anesthesia and Analgesia Commons, Other Psychiatry and Psychology Commons, Pain Management Commons, Pediatrics Commons, Psychiatry Commons, Surgery Commons, Surgical Procedures, Operative Commons
Comments
NOTICE: this is the author’s version of a work that was accepted for publication in International Journal of Pediatric Otorhinolaryngology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Pediatric Otorhinolaryngology, volume 123, in 2019. https://doi.org/10.1016/j.ijporl.2019.04.005
The Creative Commons license below applies only to this version of the article.