Perfusion Index as an Objective Measure for Postoperative Pain Assessment in Pediatric Patients.

Objectives: Adequate postoperative pain management is crucial in pediatric patients undergoing cardiac surgery because pain can lead to devastating short- and long-term consequences. This review discusses the limitations of current postoperative pain assessment and management in children after cardiac surgery, the obstacles to providing optimal treatment, and concepts to consider that may overcome these barriers. Data Source: MEDLINE and PubMed. Conclusions: Effective pain management in infants and young children undergoing cardiac surgery continues to evolve with innovative methods of both assessment and therapy using newer drugs or novel routes of administration. Artificial intelligence– and machine learning–based pain assessment and patient-tailored management in both pain measurement and prevention are already being integrated into the routine of current practice.

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Using an App to monitor postoperative pain at home in pediatric patients

Journal of Child Health Care ◽

10.1177/1367493520919313 ◽

2021 ◽

pp. 136749352091931

Author(s):

Emanuela Tiozzo ◽

Valentina Biagioli ◽

Matilde Brancaccio ◽

Riccardo Ricci ◽

Anna Marchetti ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Health Professionals ◽

Pediatric Patients ◽

Pain Scale ◽

Factors Associated ◽

Prospective Comparative Study ◽

Paper And Pencil ◽

The Impact ◽

At Home

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

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Prevalence and Contributing Factors Associated With Postoperative Pain in Pediatric Patients: A Cross-Sectional Follow-up Study

Perioperative Care and Operating Room Management ◽

10.1016/j.pcorm.2021.100159 ◽

2021 ◽

Vol 23 ◽

pp. 100159

Author(s):

Zemenay Ayinie Mekonnen ◽

Debas Yaregal Melesse ◽

Habitamu Getinet Kassahun ◽

Tesera Dereje Flatie ◽

Misganaw Mengie Workie ◽

...

Keyword(s):

Postoperative Pain ◽

Pediatric Patients ◽

Contributing Factors ◽

Cross Sectional ◽

Factors Associated ◽

Follow Up Study

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The Postoperative Pain Assessment Skills Pilot Trial

Pain Research and Management ◽

10.1155/2011/278397 ◽

2011 ◽

Vol 16 (6) ◽

pp. 433-439 ◽

Cited By ~ 13

Author(s):

Michael McGillion ◽

Adam Dubrowski ◽

Robyn Stremler ◽

Judy Watt-Watson ◽

Fiona Campbell ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Assessment ◽

Health Care Professionals ◽

Pilot Trial ◽

Standardized Patients ◽

Analysis Of Covariance ◽

Group Differences ◽

Pain Beliefs ◽

Assessment Skills ◽

Deteriorating Patient

BACKGROUND/OBJECTIVES: Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs’ assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method – deteriorating patient-based simulation (DPS) – versus SPs for improving HCPs’ pain knowledge and assessment skills.METHODS: Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs’ pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the Pain Beliefs Scale (PBS), the Satisfaction with Simulated Learning Scale (SSLS) and the Simulation Design Scale (SDS), respectively. Student’sttests were used to test for overall group differences in postintervention PAST, SSLS and SDS scores. One-way analysis of covariance tested for overall group differences in PBS scores.RESULTS: DPS and SP groups did not differ on post-test PAST, SSLS or SDS scores. Knowledge of pain-related misbeliefs was also similar between groups.CONCLUSIONS: These pilot data suggest that DPS is an effective simulation alternative for HCPs’ education on postoperative pain assessment, with improvements in performance and knowledge comparable with SP-based simulation. An equivalence trial to examine the effectiveness of deteriorating patient-based simulation versus standardized patients is warranted.

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Assessment of pain during rest and during activities in the postoperative period of cardiac surgery

Revista Latino-Americana de Enfermagem ◽

10.1590/0104-1169.3115.2391 ◽

2014 ◽

Vol 22 (1) ◽

pp. 136-143 ◽

Cited By ~ 6

Author(s):

Larissa Coelho de Mello ◽

Silvio Fernando Castro Rosatti ◽

Priscilla Hortense

Keyword(s):

Cardiac Surgery ◽

Postoperative Pain ◽

Postoperative Complications ◽

Postoperative Period ◽

Pain Assessment ◽

Descriptive Study ◽

Deep Breathing ◽

Cohort Design ◽

Surgical Recovery ◽

Over Time

OBJECTIVE: to assess the intensity and site of pain after Cardiac Surgery through sternotomy during rest and while performing five activities. METHOD: descriptive study with a prospective cohort design. A total of 48 individuals participated in the study. A Multidimensional Scale for Pain Assessment was used. RESULTS: postoperative pain from cardiac surgery was moderate during rest and decreased over time. Pain was also moderate during activities performed on the 1st and 2nd postoperative days and decreased from the 3rd postoperative day, with the exception of coughing, which diminished only on the 6th postoperative day. Coughing, turning over, deep breathing and rest are presented in decreased order of intensity. The region of the sternum was the most frequently reported site of pain. CONCLUSION: the assessment of pain in the individuals who underwent cardiac surgery during rest and during activities is extremely important to adapt management and avoid postoperative complications and delayed surgical recovery.

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Multimodal spatio-temporal deep learning approach for neonatal postoperative pain assessment

Computers in Biology and Medicine ◽

10.1016/j.compbiomed.2020.104150 ◽

2021 ◽

Vol 129 ◽

pp. 104150

Author(s):

Md Sirajus Salekin ◽

Ghada Zamzmi ◽

Dmitry Goldgof ◽

Rangachar Kasturi ◽

Thao Ho ◽

...

Keyword(s):

Deep Learning ◽

Postoperative Pain ◽

Pain Assessment ◽

Learning Approach ◽

Spatio Temporal

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Knowledge translation and process improvement interventions increased pain assessment documentation in a large quaternary paediatric post-anaesthesia care unit

BMJ Open Quality ◽

10.1136/bmjoq-2018-000319 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000319 ◽

Cited By ~ 2

Author(s):

Daniel Stocki ◽

Conor McDonnell ◽

Gail Wong ◽

Gloria Kotzer ◽

Kelly Shackell ◽

...

Keyword(s):

Postoperative Pain ◽

Knowledge Translation ◽

Pain Intensity ◽

Process Improvement ◽

Nursing Staff ◽

Pain Assessment ◽

Pain Intensity Score ◽

Chart Audit ◽

Anaesthetic Care ◽

Pacu Stay

BackgroundDue to inadequate pain assessment documentation in our paediatric post-anaesthetic care unit (PACU), we were unable to monitor pain intensity, and target factors contributing to moderate and severe postoperative pain in children. The purpose of this study was to improve pain assessment documentation in PACU through a process improvement intervention and knowledge translation (KT) strategy. The study was set in a PACU within a large university affiliated paediatric hospital. Participants included PACU and Acute Pain Service nursing staff, administrative staff and anaesthesiologists.MethodsThe Plan–Do–Study-Act method of quality improvement was used. Benchmark data were obtained by chart review of 99 patient medical records prior to interventions. Data included pain assessment documentation (pain intensity score, use of validated pain intensity measure) during PACU stay. Repeat chart audit took place at 4, 5 and 6 months after the intervention.InterventionKey informant interviews were conducted to identify barriers to pain assessment documentation. A process improvement was implemented whereby the PACU flowsheets were modified to facilitate pain assessment documentation. KT strategy was implemented to increase awareness of pain assessment documentation and to provide the knowledge, skill and judgement to support this practice. The KT strategy was directed at PACU nursing staff and comprised education outreach (educational meetings for PACU nurses, discussions at daily huddles), reminders (screensavers, bedside posters, email reminders) and feedback of audit results.ResultsThe proportion of charts that included at least one documented pain assessment was 69%. After intervention, pain assessment documentation increased to >90% at 4 and 5 months, respectively, and to 100% after 6 months.ConclusionAfter implementing process improvement and KT interventions, pain assessment documentation improved. Additional work is needed in several key areas, specifically monitoring moderate to severe pain, in order to target factors contributing to significant postoperative pain in children.

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