Date of Award

12-2011

Document Type

Independent Study

Degree Name

Master of Science (MS)

Abstract

Intraoperative Pain Management: Attenuating Postoperative Pain in Pediatric Patients

More than 5 million children undergo surgery in the United States each year, and it is estimated that up to 75% (3.75 million) of them experience significant postoperative pain (Fortier, MacLaren, Martink, Perret-Karimi, & Kain, 2009). While we have come a long way in our knowledge of pain in children, it is often found that pain is inadequately assessed and treated. Aside from the cost associated with increased utilization of medical visits, psychological implications (anxiety, avoidance, sleep disturbances), and increased parental distress related to pediatric pain, there are many physiologic changes associated with pain that may delay or prevent wound healing. Increasing awareness of pharmacologic trends in pediatric analgesia may assist anesthesia staff in providing adequate intraoperative analgesia and decreasing postoperative pain.

the extensive amount of research available on this topic, for the purposes of this independent project, research will be limited to those children ages 2-12 years old undergoing tonsillectomy and adenoidectomy (T &A). T &A is one of the most common pediatric surgical procedures and is well known to be associated with significant postoperative pain (Fortier et al., 2009).

The purpose of this independent project is to identify pharmacologic agents that are presently being employed intraoperatively to provide analgesia to the pediatric population. A comprehensive review of the literature was performed using PubMed and CINAHL databases. Current research findings on the topic of interest and related topics were reviewed. Malsack and Wall's gate control theory of pain was used as a theoretical framework.

Pain is defined by the International Association for the Study of Pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (!ASP, 1994). Certified Registered Nurse Anesthetists (CRNAs) and other anesthesia providers are responsible for providing anesthesia, amnesia, and analgesia to patients who are undergoing surgical procedures. Analgesia is defined as the absence of pain in response to stimulation which would nounally be painful (IASP, 1994). The physiological indicators of blood pressure, hem rate, and respiratory rate are among the most commonly used to assess pain in patients who are anesthetized. Inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment (IASP, 1994

Good pain management is associated with improved outcomes from surgery, quicker clinical recovery, shorter hospital stays, fewer readmissions, improved quality of life, and improved patient and parent satisfaction (Trudeau, Lamb, Gowans, & Lauder, 2009). 1n light of the present advances in technology and the progress that has been made in the science of pharmacology, a specific formula for providing children the most effective analgesia has eluded healthcare providers due to variability in children's perception and response to pain. Research conducted on the pediatric population is also subject to many ethical considerations which results in comparably few randomized controlled trials that direct pain management in children. Anesthesia providers must strive to provide adequate analgesia to the pediatric population. The clinical question of interest remains: what pharmacologic agents utilized intraoperatively provide the most effective analgesia in the immediate postoperative period?

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