title: Substantial postoperative pain is common among children undergoing laparoscopic appendectomy.
abstract: BACKGROUND
  Laparoscopic appendectomy is one of the most common surgical procedures performed in children. However, to our knowledge, the postoperative pain experience of children undergoing laparoscopic appendectomy has never been described. In this study, we assessed the postoperative pain experience of children undergoing laparoscopic appendectomy.
  
  
  METHODS
  A retrospective chart review of children aged 9-17 years undergoing laparoscopic appendectomy at a large academic medical center from 2004 to 2010 was performed. Demographic and clinical characteristics and self-reported pain scores (0-10 numeric rating scale) during hospitalization were abstracted from the medical record. Pain scores ≥4 were classified as moderate or severe. If ≥60% of pain ratings were moderate or severe during a specified time period (e.g., particular postoperative day), then the child was defined as experiencing substantial pain during that time. Pain outcomes were summarized using descriptive statistics. Secondary analyses assessed the predictors of substantial postoperative pain.
  
  
  RESULTS
  Hundred and eighty-six children underwent laparoscopic appendectomy during the study period. One in three children experienced substantial postoperative pain on the day of surgery, and one in five children continued to have substantial pain the next day. Commonly available clinical and demographic characteristics were poor predictors of substantial postoperative pain.
  
  
  CONCLUSIONS
  These preliminary data suggest that substantial postoperative pain is common in children undergoing laparoscopic appendectomy. More studies of postoperative pain outcomes among children undergoing laparoscopic appendectomy and other common pediatric surgical procedures are needed.
authors.affiliation: Department of Anesthesiology, University of North Carolina, Chapel Hill, NC 27599-7455, USA. mtomecka@aims.unc.edu
authors.forename: Maggie J
authors.initials: MJ
authors.lastname: Tomecka
authors.forename: Andrey V
authors.initials: AV
authors.lastname: Bortsov
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Miller
authors.forename: Natalie
authors.initials: N
authors.lastname: Solano
authors.forename: John
authors.initials: J
authors.lastname: Narron
authors.forename: Peggy P
authors.initials: PP
authors.lastname: McNaull
authors.forename: Karene J
authors.initials: KJ
authors.lastname: Ricketts
authors.forename: Concetta M
authors.initials: CM
authors.lastname: Lupa
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery; D002648:Child; D003627:Data Interpretation, Statistical; D003710:Demography; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D015588:Observer Variation; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D018685:Anesthetics, Inhalation