The incidence of postoperative pain in children

The incidence of pain in 170 children recovering from surgery was surveyed in two major teaching hospitals along with an analysis of analgesic medication prescribed and administered. Analgesic medication was not ordered for 16% of the patients and narcotic analgesic medication ordered was not given for 39% of the patients. In 29% of the patients, where an order for "narcotic or non-narcotic analgesic medication' was written, the non-narcotic drug was given exclusively. Irrespective of the treatments received, only 25% of the patients were pain free on the day of surgery and 13% reported severe pain. By the first postoperative day, 53% reported no pain but 17% still reported severe pain. There appeared to be no relationship between ages of patients and severity of pain reported. Analysis of orders written for postoperative analgesics revealed extremely variable prescribing habits of the medical staff and that doses frequently were too small and/or too infrequent. The majority of orders were written "PRN' which often was interpreted by nursing staff as "as little as possible.' Nursing staff also preferred not to give narcotic medications but substituted non-narcotic analgesics, even soon after surgery. Many of the children surveyed became withdrawn and this was interpreted as coping with pain. Others expressed a dread of "the needle' as a way of administering analgesics and preferred to suffer pain to an injection. We have concluded that there is considerable scope to improve pain management in children after surgery. This improvement must be based on improved education of medical and nursing staff in contemporary clinical pharmacology and on improved communication between staff, parents and patients.