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

• Published in: Pediatric transplantation 2006-03, Vol.10 (2), p.172-177
• Main Authors: Sharek, Paul J., Wayman, Karen, Lin, Eugenia, Strichartz, Debra, Sentivany-Collins, Sandy, Good, Julie, Esquivel, Carlos, Brown, Michelle, Cox, Kenneth
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; children; Female; Health Education; Humans; Infant; Length of Stay; liver transplant; Liver Transplantation; Male; Medical sciences; non-pharmacologic; pain management; Pain Measurement; pain scores; Pain, Postoperative - prevention & control; Parents; Patient Education as Topic; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2005.00438.x

:  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