An examination of child temperament as a predictor of parental post-operative analgesic administration.

The purpose of this study was to examine children's temperament as a predictor of post-operative analgesics administered by parents after controlling for post-operative pain severity, surgery severity, and parental misconceptions regarding pain medication for children. Participants included 286 Spanish- and English-speaking parents of children ages 1-18 (IQR: 3-8) undergoing outpatient elective surgery. Parents completed measures of baseline temperament, parental medication attitudes, and demographics preceding their child's surgery and recorded pain intensity and doses of analgesics administered (nonopioid and opioid) on postoperative days 1, 3, and 7. Pearson product-moment correlations revealed that emotionality was significantly associated with acetaminophen, ibuprofen and hydrocodone and shyness was significantly associated with acetaminophen and hydrocodone. Hierarchical linear regression analysis revealed emotionality as a significant independent predictor of acetaminophen, ibuprofen and hydrocodone administered (F(4, 72)=2.82, F(4, 73)=1.53, F(4, 58)=8.75, respectively). Dimensions of children's temperament, specifically emotionality, predict analgesic administration by parents following surgery even after controlling for confounding variables. These findings highlight the need for tailored interventions targeting management of children's pain in the home setting and suggest that both proximal (e.g., pain severity) and distal (e.g., child temperament) factors may be necessary intervention components.

Zolghadr S ，Fortier MA ，Winckler B ，Kain ZN ... -  《-》

Children and their parents' assessment of postoperative surgical pain: Agree or disagree?

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. 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). 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. 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.

Kaminsky O ，Fortier MA ，Jenkins BN ，Stevenson RS ，Gold JI ，Zuk J ，Golianu B ，Kaplan SH ，Kain ZN ... -  《-》

Parental assessment of pain control following pediatric adenotonsillectomy: Do opioids make a difference?

Postoperative prescribing of opioids following pediatric adenotonsillectomy can have negative consequences including unnecessary opioid exposure and potential for respiratory depression. While guidelines from The American Academy of Otolaryngology/Head & Neck Surgery recommend treatment of post adenotonsillectomy pain using acetaminophen and ibuprofen, many providers continue to prescribe opioids and may do so, in part with concern for parental dissatisfaction with post-operative analgesia. Our aim was to determine whether a post-operative prescription for opioids affects parental assessment of pain control following pediatric adenotonsillectomy. This post-operative survey assessed the parental assessment of pain control in 324 patients, ages 1-17 years undergoing adenotonsillectomy. This study was conducted at a quaternary care children's hospital in Houston, Texas from December 1, 2018 through March 31, 2019. Post-operative pain regimens included acetaminophen and ibuprofen or combination hydrocodone/acetaminophen in addition to ibuprofen for post-operative analgesia based on the attending surgeons prescribing preferences. The primary study outcome was identification of the proportion of parents rating their child's analgesia following pediatric adenotonsillectomy as poor or inadequate based on the post-operative analgesic regimen including opioids. Of the 798 surveys sent, the response rate was 42% (324/775) of those who received the survey email, and 69% (324/470) for those who opened the email. Between the opioid and non-opioid groups, there was no difference in gender (male; 48% vs. 51.3%; p = 0.58), race/ethnicity (white; 53% vs. 46%; p = 0.35) or insurance status (insured; 62% vs. 50.9%; p = 0.06). The proportion of parents who rated their child's pain as poor or inadequately controlled following adenotonsillectomy was relatively rare: 9% and 5% in the non-opioid and opioid groups, respectively. Parents rating their child's pain as excellent with regards to pain control following adenotonsillectomy were 58% and 50% in the non-opioids and opioid groups respectively. The results of this study indicate that non-opioid analgesic regimens following pediatric adenotonsillectomy were not associated with decreased parental satisfaction or an increasing assessment of poor or inadequately controlled pain. Limiting opioid exposure following pediatric adenotonsillectomy is feasible and does not result in worse parental satisfaction with the analgesic plan.

Adler AC ，Mehta DK ，Messner AH ，Salemi JL ，Chandrakantan A ... -  《-》

Postoperative pain management in Latino families: parent beliefs about analgesics predict analgesic doses provided to children.

The present study examined whether parental perceptions of children's pain impacted home-based pain management following outpatient surgery in a sample of Latino families from low socioeconomic backgrounds. Latino parents of children (n = 161) who underwent outpatient surgery were recruited for this study and completed measures assessing attitudes on pain and analgesic use (Parental Pain Expression Perceptions and Medication Attitudes Questionnaire) before their child's surgery. Parents also rated their child's pain after their child's surgery using the Parent Postoperative Pain Measure and collected data on the amount of analgesics they gave to their child on the first postoperative day. Hierarchical regression analyses examined whether parental attitudes predicted pain assessment and management at home. A majority of parents reported multiple misconceptions regarding children's pain and fears of side effects as well as avoidance of analgesic use. For example, over 80% reported believing that a child always tells their parents when they are in pain. Hierarchical regression analyses found that more fear and avoidance regarding analgesic use for children's pain predicted parents providing fewer doses of analgesic to their children on the first postoperative day (β = -0.21, P = 0.028). Preoperative parents' beliefs regarding analgesics for treatment of children's pain may adversely impact parent postoperative analgesic administration at home in Latino families.

Rosales A ，Fortier MA ，Campos B ，Kain ZN ... -  《-》

Temperament: a variable in children's pain management.

Wallace MR 《-》