Analgesic use and favourable patient-reported outcome measures after paediatric surgery: an analysis of registry data.

Bernhart, Kyra; Becke-Jakob, Karin; Lehmann, Thomas; Harnik, Michael; Seiler, Stefan; Meissner, Winfried; Stüber, Frank; Stamer, Ulrike M (2023). Analgesic use and favourable patient-reported outcome measures after paediatric surgery: an analysis of registry data. British journal of anaesthesia, 130(1), pp. 74-82. Elsevier 10.1016/j.bja.2022.09.028

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BACKGROUND

Pain after paediatric appendectomy and tonsillectomy is often undertreated. Benchmarking of hospitals could reveal which measures are associated with improved patient- or parent-reported pain-related outcomes.

METHODS

A total of 898 anonymised cases from 11 European hospitals participating in PAIN OUT infant were analysed. The children completed a questionnaire on patient-reported outcomes (PROs) 24 h after surgery. According to a composite PRO measure, including pain intensity and pain-related interference, hospitals were allocated to Group I (favourable results), II (average results), and III (unfavourable results). Benchmarking of hospital groups was performed investigating process variables (dosing of non-opioid analgesics, opioids, and dexamethasone) associated with PROs, side-effects, and children's perception of care. Variables associated with PROs were analysed using multinomial regression analysis with the PRO score-related hospital group as a dependent variable (estimated odds ratios [OR], 95% confidence interval [CI]).

RESULTS

During the first 24 h after surgery, 1.2 (1.1-1.3) full daily doses of non-opioid analgesics (non-steroidal anti-inflammatory drug [NSAID], paracetamol, metamizole) were administered in group I and 0.7 (0.6-0.8) in group III (P<0.001). Intraoperative dexamethasone was administered to 70.1 and 52.6% of the children in Group I and Group III, respectively (P<0.001). A lower number of full daily doses of non-opioid analgesics: 0.22 [0.15-0.31]), less dexamethasone (0.49 [0.33-0.71]), fewer non-opioid analgesics before the end of surgery (0.37 [0.22-0.62]) and higher opioid doses were associated with hospital allocation to group III vs group I (Nagelkerke's R2=0.433).

CONCLUSIONS

The results indicated substantial deficits in the concept, application, and dosing of analgesics in paediatric patients after surgery. Timely administration of adequate analgesic doses can easily be introduced into daily clinical practice.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov NCT02083835.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Anästhesiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Anästhesiologie
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy > Partial clinic Insel

UniBE Contributor:

 Harnik, Michael, Seiler, Stefan Jürg, Stüber, Frank, Stamer, Ulrike

Subjects:

 600 Technology > 610 Medicine & health

ISSN:

 1471-6771

Publisher:

 Elsevier

Language:

 English

Submitter:

 Pubmed Import

Date Deposited:

 07 Dec 2022 11:29

Last Modified:

 02 Jan 2023 00:15

Publisher DOI:

 10.1016/j.bja.2022.09.028

PubMed ID:

 36470745

Uncontrolled Keywords:

 appendectomy non-opioid analgesics paediatric analgesia pain-related interference patient-reported outcomes tonsillectomy

BORIS DOI:

 10.48350/175530

URI:

 https://boris.unibe.ch/id/eprint/175530

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