An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomy.
BACKGROUND
A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children.


METHODS
We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations < 92%), and hospital length of stay.


RESULTS
Pain scores were documented more frequently after the implementation of the APS (61% vs 48.5%). Sedation scores were documented only after the implementation of the APS. Postoperative desaturation was significantly more frequent in the pre-APS group compared to the APS group (45.5% vs 6.8%, P < 0.001). Despite the fact that the epidural catheter was in place for the same duration for both groups [median of 3 days (3-3 25-75%ile)], the duration of hospitalization was 1 day shorter in the APS group compared to the pre-APS group [median of 5 (5-5 25-75%ile) vs 6 (5-6 25-75%ile) days, P < 0.001].


CONCLUSIONS
Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day.
Department of Anesthesiology, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada. chantal.frigon@muhc.mcgill.ca
Chantal
C
Frigon
Witthaya
W
Loetwiriyakul
Manon
M
Ranger
Annik
A
Otis
D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010100:Oxygen / Q000378:metabolism; D018710:Pain Clinics; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D019051:Rhizotomy / Q000379:methods*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine; D010100:Oxygen