Postoperative Analgesie bei „tageschirurgischen“ Kindern aus der Sicht der Eltern
After minor day surgery carried out under a general anaesthetia in children in good general health, adequate pain therapy for the postoperative period can present problems. One reason for this is that postoperative pain is difficult to objectivize, especially in young children; a further point is that neither the anaesthetist nor the surgeon can monitor the effects and/or side-effects of the analgesic medication.
It seemed it would be useful to find out to what extent a peripherally acting, relatively mild analgesic is adequate to the task of pain relief good enough for the post-operative period. To this end, questionnaires were distributed over a period of 6 months. The questions concerned the quality of pain relief in the hospital and at home, the total consumption of analgesics up to the 2nd postoperative day and the recollection of pain. Children between 2 and 14 years of age were enrolled in the study. Each was admitted to a polyclinic on the morning of the operation and discharged from hospital about 6 h after the intervention. Midazolam 0.4 mg/kg body weight p.o. was given as premedication and full anaesthesia was accomplished with halothane laughing gas. Simultaneously with the induction of anaesthesia paracetamol was administered in suppository form: 250 mg for children with body weight between 10 and 20 kg and 500 mg for those weighing between 20 and 30 kg.
The parents and the ward sister completed monitoring sheets with parameters vigilance and pain in the recovery room and on the ward, these were used as the basis of decision-making on the administration of further pain medication at home.
After the operation, 64% of the children complained of pain, so that administration of further analgesic medication was necessary on the ward.
At home, however, 70% of the children received no further analgesic medication; 26.2% received paracetamol in suppository form from their parents for the night, and only 3.8% needed more pain medication beyond this. Diagnostic interventions such as cystoscopy and rectoscopy involved the smallest consumption of analgesics. It was striking that despite the comparable surgical field there were distinctly more reports of pain following correction of undescended testes than after herniotomy. The trauma the children suffered as a result of their presence in hospital is reflected mainly in their recollections of pain. Among 116 children who had undergone herniotomy, 96 (83%) either could not remember being in pain at all or remembered only slight pain. Only 6% of the children remembered severe pain. Following surgery for correction of inguinal testes, however, as many as 30% of these children remembered severe or at least unpleasant pain. Operations for release of phimosis were followed by the lowest analgesic consumption in the immediate postoperative period and the least recollection of pain, obviously because regional anaesthesia of the penile shaft was also induced during the operation.
The parents’ involvement in the matter of postoperative pain therapy was extremely high. The overall sparing consumption of pain-relieving drugs in the home could not have been foreseen on the basis of the immediate postoperative phase in the hospital. This suggests that the familiar home environment distracted the children from the pain resulting from the operation wound. The efficacy of peripheral analgesics such as paracetamol was assessed as satisfactory by most parents and also by most of the children following minor operations such as herniotomy. The analgesic medication should be administered at the same time as the premedication for the maximum effective level to be exploited to best advantage. The children who had undergone herniotomy remembered their thirst and the indwelling catheter after the operation as being just as bad as the actual pain from the wound. After correction of inguinal testes, however, there was a distinctly higher consumption of analgesic drugs even in the recovery room, but more so on the ward and in the home environment. The children also had more unpleasant memories of pain after orchidopexy.
It would be desirable to intensify the pain therapy in such cases, especially in the immediate postoperative phase, when the pain is most severe. This would be possible by relatively simple and safe additional procedures, such as nerve blocks or caudal anaesthesia. Positive results were demonstrable in the children operated on for phimosis. It would also certainly make it possible to reduce analgesic consumption, attenuate the memories of pain and mitigate the hospital-induced psychological trauma following orchidopexy.
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