Improved pain management in pediatric postoperative liver transplant patients using parental education and non-pharmacologic interventions

Authors: Sharek, Paul J.; Wayman, Karen¹; Lin, Eugenia²; Strichartz, Debra¹; Sentivany-Collins, Sandy³; Good, Julie³; Esquivel, Carlos⁴; Brown, Michelle⁵; Cox, Kenneth¹

Source: Pediatric Transplantation, Volume 10, Number 2, March 2006 , pp. 172-177(6)

Publisher: Wiley-Blackwell

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Abstract:

Sharek PJ, Wayman K, Lin E, Strichartz D, Sentivany-Collins S, Good J, Esquivel C, Brown M, Cox K. Improved pain management in pediatric postoperative liver transplant patients using parental education and non-pharmacologic interventions.

A pain management intervention, consisting of pretransplant parental education and support, pre- and postoperative behavioral pediatrics consultation, postoperative physical and occupational therapy consultation, and implementation of non-pharmacologic pain management strategies, was introduced to all pediatrics patients receiving liver transplants at Lucile Packard Children's Hospital beginning August 2001. Children receiving transplants pre-intervention (May, 2000 to February, 2001) and post-intervention (August, 2001 to March, 2002) were compared using pain scores, parent perception of pain ratings, length of stay, ventilator days, total cost, and opioid use. A total of 27 children were evaluated (13 historical control, 14 intervention). The two populations did not differ on age at transplant (mean age 53.8 vs. 63.6 months), sex (46.1% vs. 50% male), ethnicity (53.8% vs. 57.1% white, non-Hispanic) weight at transplant (17.5 vs. 24.7 kg), percent with biliary atresia as the primary reason for transplant (42.9% vs. 69.2%), percent with status 1 transplant listing score (38.5% vs. 50.0%), or public insurance status (30.8 vs. 57.2% with Medicaid). No differences were found in mean pediatric intensive care unit (PICU) postoperative length of stay (6.7 vs. 5.3 days), total postoperative length of stay (17.5 vs. 17.5 days), total inpatient length of stay (27.0 vs. 24.4 days), time to extubation (30 vs. 24.3 h), total cost ($147 983 vs. $157 882) or opioid use through postoperative day (POD) 6 (0.24 vs. 0.25 mg/kg/day morphine equivalent). A decrease in mean pain score between POD 0 and 6 (2.82 vs. 2.12; p = 0.047), a decrease in mean parental pain perception score (3.1 vs. 2.1; p = 0.001), and an increase in number of pain assessments per 12 h shift (3.43 vs. 6.79; p < 0.005) were seen. A comprehensive non-pharmacologic postoperative pain management program in children receiving a liver transplant was associated with decreased pain scores, improved parent perception of pain, and an increased number of pain assessments per 12 h shift. No increases in lengths of stay (PICU, postoperative, total), time to extubation, or total cost were found.

Keywords: liver transplant; pain management; pain scores; non-pharmacologic; children

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1399-3046.2005.00438.x

Affiliations: 1: Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine 2: Department of Quality Management, Lucile Packard Children's Hospital 3: Pain Management Service, Department of Anesthesiology, Stanford University School of Medicine 4: Department of Surgery, Stanford University School of Medicine 5: Division of Child Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

Publication date: 2006-03-01

Improved pain management in pediatric postoperative liver transplant patients using parental education and non-pharmacologic interventions

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