title: Pain management in children with and without cognitive impairment following spine fusion surgery.
abstract: BACKGROUND
  We compared pain assessment and management practices in children with and without cognitive impairment (CI) undergoing spine fusion surgery.
  
  
  METHODS
  The medical records of 42 children (19 with CI and 23 without) were reviewed and data related to demographics, surgery, pain assessment and management, and side-effects were recorded.
  
  
  RESULTS
  Fewer children with CI were assessed for pain on postoperative days (POD) 0-4 compared to those without CI (P < 0.002). Self-report was used for 81% of pain assessments in children without CI, while a behavioural tool was used for 75% of assessments in cognitively impaired children. Children with CI received smaller total opioid doses on POD 1-3 compared to those without CI (P < or = 0.02). Furthermore, children without CI received patient/nurse-controlled analgesia for more postoperative days than children with CI (P=0.02).
  
  
  CONCLUSIONS
  Our data demonstrate a discrepancy in pain management practices in children with and without CI following spine fusion.
authors.affiliation: Department of Anesthesiology, University of Michigan Health Systems, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0211, USA. smalviya@umich.edu
authors.forename: S
authors.initials: S
authors.lastname: Malviya
authors.forename: T
authors.initials: T
authors.lastname: Voepel-Lewis
authors.forename: A R
authors.initials: AR
authors.lastname: Tait
authors.forename: S
authors.initials: S
authors.lastname: Merkel
authors.forename: A
authors.initials: A
authors.lastname: Lauer
authors.forename: H
authors.initials: H
authors.lastname: Munro
authors.forename: F
authors.initials: F
authors.lastname: Farley
mesh_terms: D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D003072:Cognition Disorders; D003142:Communication; D005260:Female; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting; D013123:Spinal Fusion
chemical_list: D000701:Analgesics, Opioid