Pain Quality After Pediatric Pectus Excavatum Repair.

BACKGROUND: Neuropathic pain medications are included in multimodal postoperative analgesic strategies, but quality of perioperative pain is rarely assessed. AIMS: The purpose of this study was to describe adolescents' pain experiences after thoracoscopic pectus excavatum repair (Nuss procedure) using the Adolescent Pediatric Pain Tool. DESIGN: This prospective descriptive longitudinal study was designed to test the hypothesis that pain quality descriptors reported are consistent with neuropathic pain. METHODS: A convenience sample of 23 adolescents aged 12 to 17 years from a single urban, university affiliated, nonprofit children's hospital consented to self-report pain using the Adolescent Pediatric Pain Tool before and during hospitalization, and up to 14 months after Nuss procedure. Visual analytic techniques were used to analyze reported pain intensity, location, and affective, evaluative, sensory, and temporal qualities. RESULTS: Postoperative pain quality, intensity, number of sites, and surface area decreased over time. Word clouds illustrated that neuropathic sensory and temporal pain quality descriptors increased in frequency 2 to 6 weeks after surgery and were the predominant descriptors 2 to 4 months after surgery. Dot matrix charts illustrated an inconsistent relationship of pain quality and intensity with pain surface area. CONCLUSIONS: Pain quality should be assessed with valid, reliable, and developmentally appropriate tools. Visual analytics help illustrate pain quality at single points in time and longitudinally and may be helpful in guiding postoperative pain treatment.

Children's Pain at Home After Laparoscopic Appendectomy.

BACKGROUND: Hospitalized children experience moderate-to-severe pain after laparoscopic appendectomy, but knowledge of children's pain experiences after discharge home is limited. Accurate pain assessments are needed to guide appropriate pain treatment. AIMS: To describe children's pain at home after laparoscopic appendectomy. DESIGN: Prospective exploratory and descriptive METHODS: A convenience sample of 100 patients, aged 10-17 years, who spoke or wrote in English or Spanish, volunteered to complete 14-day pain diaries at home after laparoscopic appendectomy. Visual analytic techniques were used to analyze patterns of pain experiences. RESULTS: Diaries were returned by 45 patients/parents, the majority of whom were White (64%), male (56%), adolescents (mean age 14 years) with no previous surgical history (70%), and whose appendix was inflamed (87%) but not perforated. More than 50% reported severe pain (4 or 5 on a 0-5 scale) on the first full day home after laparoscopic appendectomy. On day 7, 40% reported pain and on day 14, 16% were still reporting pain. Only rarely were pain scores not clinically significantly lower 1 hour after pain treatment, regardless of treatment type (e.g., nondrug, nonopioid, opioid). Reported pain intensity steadily decreased over time as did frequency of recorded pain scores. CONCLUSION: Adolescents experience severe pain at home after laparoscopic appendectomy and some experience pain for 7 to 14 days after hospital discharge. Visual analytics better represent the dynamics of pain experiences than measures of central tendency.

Children's Opioid Use at Home After Laparoscopic Appendectomy.

BACKGROUND: To combat the opioid epidemic, prescribers need accurate information about pediatric home opioid requirements to manage acute pain after surgery. Current opioid use estimates come from retrospective surveys; this study used medication adherence technology (eCAP) to track home opioid use. PURPOSE: To describe children's pain treatment at home after laparoscopic appendectomy, and to compare self-reported opioid analgesic use to eCAP data and counts of returned pills. DESIGN: Prospective exploratory and descriptive study METHODS: A convenience sample of 96 patients, 10-17 years of age, from a single urban nonprofit children's hospital consented to self-report pain treatment in 14-day diaries and use eCAP to monitor prescribed opioid use at home after laparoscopic appendectomy. RESULTS: Patients were prescribed 5-45 opioid-containing pills (mean ± standard deviation 15 ± 7.2). Of 749 opioid-containing pills prescribed to 49 patients who returned data, 689 pills were dispensed, 167.5 were used for the reason prescribed, 488 were returned to families for disposal, and 53.5 were missing. The majority of the 49 patients were opioid naïve (72%), Caucasian (64%), and male (56%), with a mean age of 14 years. Patients used 6.6 ± 6.3 opioid-containing pills by pill count and 5.6 ± 5.1 by self-report, a significant difference (p = .004). Unreported eCAP-enabled pill bottle openings typically occurred on weekends. CONCLUSION: Medication adherence technology (eCAP) is a more rigorous method than self-report to estimate opioid needs and detect early opioid misuse. Additional rigorously designed studies of postoperative opioid use are needed to guide opioid prescribing.