Thứ ba, 19 Tháng 4 2011 08:50

Pain Relief Often Lacking in Inpatient Pediatric Procedures

Written by Laurie Barclay, MD
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(ĐTĐ) - Less than one third of painful procedures for hospitalized children are associated with documented pain relief, according to the results of a study reported online April 4 in the Canadian Medical Association Journal.


"Children being cared for in hospital undergo multiple painful procedures daily," write Bonnie J. Stevens, RN, PhD, from The Hospital for Sick Children and the University of Toronto, Ontario, Canada and colleagues from the Canadian Institutes of Health Research Team in Children's Pain. "However, little is known about the frequency of these procedures and associated interventions to manage the pain. We undertook this study to determine, for children in Canadian hospitals, the frequency of painful procedures, the types of pain management interventions associated with painful procedures and the influence of the type of hospital unit on procedural pain management."

The investigators reviewed medical records of patients 18 years or younger who were admitted between October 2007 and April 2008 to 32 inpatient units at 8 Canadian pediatric hospitals. The investigators recorded all painful procedures performed and pain management interventions used in the 24-hour period before data collection was recorded. Analysis of variance and χ2 were used to descriptively and comparatively analyze these data.

At least 1 painful procedure was identified for 2987 (78.2%) of the 3822 children whose records were reviewed, yielding a total of 18,929 painful procedures. Among children who had any painful procedure, the mean number of painful procedures was 6.3 per child.

Of the 2987 children who had a painful procedure, a pain management intervention in the previous 24 hours was documented in the chart for 2334 children (78.1%), including 1980 (84.8%) who had a pharmacologic intervention, 609 (26.1%) who had a physical intervention, 584 (25.0%) who had a psychological intervention, and 753 (32.3%) who had a combination of these interventions.

Only 844 (28.3%) of the 2987 children had administration of at least 1 pain management intervention documented specifically for a painful procedure. The highest proportion of painful procedures and analgesics administered occurred in pediatric intensive care units.

"For less than one-third of painful procedures was there documentation of one or more specific pain management interventions," the study authors write. "Strategies for implementing changes in pain management must be tailored to the type of hospital unit."

Limitations of this study include retrospective record review, possible failure of documentation to reflect actual practices, and possible inflation of a type 2 error.

"Decreases in the number of painful procedures performed and improvement in pain management associated with procedures are essential to relieve pain and suffering and to capitalize on the associated benefits for patients and the decreased use of health care resources," the study authors conclude. "Careful consideration of the need for painful procedures for pediatric inpatients and the importance of ensuring a balanced array of pharmacologic and nonpharmacologic interventions should be emphasized during health care professionals' training. Current evidence-based guidelines for dealing with procedural pain and future research using prospective study designs should address and reflect the benefits of documentation that will allow for precise determination of the efficacy of various pain management approaches."

The Canadian Institutes of Health Research supported this study. Some of the study authors have disclosed various financial relationships with Gebauer, Hawaii Medical, Ferndale Laboratories, Wyeth, and/or J&J Research & Development.

Canadian Med Assoc J. Published online April 4, 2011. Full text

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