Olivia Kaminsky1, Michelle A Fortier2, Brooke N Jenkins3, Robert S Stevenson4, Jeffrey I Gold5, Jeannie Zuk6, Brenda Golianu7, Sherrie H Kaplan8, Zeev N Kain9. 1. University of California-Irvine School of Medicine, USA, 1001 Health Sciences Rd., Irvine, CA, USA. 2. UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA; Department of Anesthesiology and Perioperative Care, University of California-Irvine, USA, 333 City Blvd West, Orange, CA, USA; Department of Pediatric Psychology, CHOC Children's, 1201 West La Veta Ave, Orange, CA, USA; Sue & Bill Gross School of Nursing, University of California-Irvine, Irvine, CA, USA. 3. UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA; Department of Anesthesiology and Perioperative Care, University of California-Irvine, USA, 333 City Blvd West, Orange, CA, USA; Department of Psychology, Chapman University, Orange, CA, USA. 4. UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA; Department of Anesthesiology and Perioperative Care, University of California-Irvine, USA, 333 City Blvd West, Orange, CA, USA. 5. Keck School of Medicine, Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, University of Southern California, USA, 1975 Zonal Ave, Los Angeles, CA, USA; Children's Hospital Los Angeles, USA, 4650 Sunset Blvd, Los Angeles, CA, USA. 6. Children's Hospital Colorado, University of Colorado School of Medicine, USA, 13123 E 16th Ave, Aurora, CO, USA. 7. Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, USA, 291 Campus Drive, Stanford, CA, USA. 8. Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, USA, 291 Campus Drive, Stanford, CA, USA; Health Policy Research Institute, University of California-Irvine, USA, 100 Theory, Suite 110, Irvine, CA, USA. 9. UCI Center on Stress and Health, School of Medicine, University of California-Irvine, Irvine, CA, USA; Department of Anesthesiology and Perioperative Care, University of California-Irvine, USA, 333 City Blvd West, Orange, CA, USA; Child Study Center, Yale University School of Medicine, USA, 230 S Frontage Rd, New Haven, CT, USA; American College of Perioperative Medicine, Irvine, CA, 15333 Culver Drive Suite 340-253, Irvine, CA, USA. Electronic address: zkain@uci.edu.
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. Published by Elsevier B.V.
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 childpain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A. Published by Elsevier B.V.
Authors: Bryan K Lao; Zeev N Kain; Dina Khoury; Brooke N Jenkins; Jeremy Prager; Robert S Stevenson; Brenda Golianu; Jeannie Zuk; Jeffrey I Gold; Qiu Zhong; Michelle A Fortier Journal: Int J Pediatr Otorhinolaryngol Date: 2020-05-11 Impact factor: 1.675