Analgesic management of postoperative pain in children: a retrospective study

A retrospective descriptive chart study was conducted to assess the pharmacological management of postoperative pain in 120 children. Four equal groups of children were studied: 1. Children between the ages of 3 through 5 years of age who had surgical procedures to correct structural deformities of the lower limbs. 2. Children between the ages of 6 through 12 years of age who had surgical procedures to correct structural deformities of the lower limbs. 3. Children, ages 3 through 5 years, who had surgery for ureteral reimplantation. 4. Children, ages 6 through 12 years who had surgery for ureteral reimplantation. A 2 x 2 factorial design was analyzed for the study, utilizing mean percentage scores across groups. Each group was compared in terms of: (1) The percent of maximum dosages of narcotic analgesics recommended by Pediatric Dosage Handbook (Shirkey, 1973) and Physician' s Desk Reference (Hubb, 1979), and the maximum dosages prescribed by physicians, (2) percentage of maximum dosages prescribed by physicians and the dosages actually given to patients, (3) average intervals between administration of narcotics. There was a statistically significant difference between the recommended dosages and physicians' prescribed dosages (p ? .001). The mean percentage of prescribed narcotic dosages was 160.93% of recommended dosages. There was also a statistically significant difference between the dosages prescribed by physicians and that administered by nurses (R 1. -001). Nurses administered 52.23% of physician prescribed narcotics during the first 24 hours and 36.31% during the 24- to 48-hour period. The mean interval between narcotics during the 48-hour postoperative period was 9.05 hours. There were no significant differences between the percentages of prescribed narcotic analgesics administered to preschool and school-aged children or between children who had undergone ureteral reimplantation surgery and orthopedic surgery. The implications of these findings will assist health care professionals in their efforts to provide appropriate postoperative pain management for children.