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- Hesselgard, Karin
(författare)
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Postoperative Intrathecal Pain Treatment in Children
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Selective dorsal rhizotomy (SDR) is an effective operations method that successfully decreased the degree of spasticity with long lasting beneficial effects for children with spastic diplegia. Children undergoing SDR are postoperatively in severe pain, a pain related to both the extensive surgical exposure with multilevel laminotomy and the nerve root manipulation. To give an optimal pain relief, pain measurement is a necessity in pain treatment, but it can be difficult in pre-school children. A worldwide survey was made (study I) to estimate the extent of SDR surgery, evaluate operation techniques and to clarify different centres pain management after SDR. A questionnaire comprise 8 questions was sent to 59 centres. 44 (75%) centres responded to the questionnaire. 33 centres constitute the study material. In a prospective study (study II), two IT different regimes was evaluated, continuous infusion versus inter-mittent, concerning pain killing and possible side effects. Intrathecal continuous infusion of bupivacaine and morphine was superior to intermittent morphine in the pain treatment after selective dorsal rhizotomy operations. To define an optimal dose (study III) of the continuous IT morphine and bupivacaine for severe pain treatment after SDR with regard to the analgesic effect and survey if they differed in side effects, we compared two different concentrations of morphine 0.4 ug/kg/h and 0.6 ug/kg/h in a fixed dose of bupivacaine 40 ug/kg/h. The Behavioural Observational Pain Scale (BOPS) was used to evaluate pain. Continuoues IT pain treatment with 0.6 ug/kg/h morphine and 40 ug/kg/h bupivacaine provides safe and good analgesia after major spinal operations. This is furthered strengthened by the fact that the adverse effect did not differ between the groups and was therefore not a drawback of the high-dose group. Effective pain management in infants and children starts with routine evaluation of pain and a clear documentation. This requires measurement of pain intensity and pain relief with reliable, valid and clinically sensitive assessment tools. Observation of behaviour can be an acceptable alternative when valid self-report is not possible. We evaluate (study IV) the validity and reliability of BOPS, as a postoperative pain measurement scale for children aged 1 - 7 years. The scale assess three variables of pain behaviours; facial expression, verbalization and body position. With BOPS the nurses can evaluate and document pain with high reliability and validity and thereby improve the postoperative pain treatment in preschool children. The simple scoring system makes BOPS easy to incorporate in a postoperative unit.
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- Hesselgard, Karin, et al.
(författare)
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Selective dorsal rhizotomy and postoperative pain management. A worldwide survey.
- 2007
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Ingår i: Pediatric Neurosurgery. - : S. Karger AG. - 1016-2291 .- 1423-0305. ; 43:2, s. 107-112
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Tidskriftsartikel (refereegranskat)abstract
- Background: Selective dorsal rhizotomy (SDR) is an operation method that decreases the degree of spasticity with long-lasting beneficial effects for children with spastic diplegia. Children undergoing SDR are postoperatively in severe pain, a pain related to both the extensive surgical exposure with multilevel laminectomy and the nerve root manipulation. Various pain management strategies for children undergoing SDR have been published. The postoperative pain treatment is a vital part of the management. The aim of this study was to estimate the number of centers performing SDR, the frequency of SDR surgery and to investigate pain management of the different centers. Methods: A questionnaire comprising 7 questions was sent by mail and/or e-mail to a total of 59 potential centers performing SDR, centers that have published material concerning SDR or centers that have been recommended. Forty-seven (80%) centers responded to the questionnaire; 11 of them do not presently perform SDR surgery, and the remaining 36 centers constitute the material of the present study. Results: 23 of the 36 centers use Peacock's operation technique and 8 centers use Park's technique. Continuous intravenous infusion of opioids for postoperative pain treatment is used by 17 (47%) of the centers. Seven (19%) centers use the epidural (ED) approach for treating postoperative pain and 6 (17%) centers use intrathecal (IT) pain treatment. The duration of intravenous ED or IT pain relief ranged from 24 h up to 7 days. To evaluate pain relief, 25 (70%) centers used some form of pain scale. Conclusion: The most common operation techniques in use today are described by Peacock or by Park, with an estimated number of procedures of more than 487/year in 36 centers. The majority of the centers seem to have a satisfactory pain management strategy. These centers administer continuous infusions of opioids, with an intravenous, ED or IT approach, and incorporate the use of a pain assessment tool to evaluate pain relief. Copyright (c) 2007 S. Karger AG, Basel
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- Hesselgard, Karin, et al.
(författare)
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Validity and reliability of the Behavioural Observational Pain Scale for postoperative pain measurement in children 1-7 years of age
- 2007
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535. ; 8:2, s. 102-108
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Pain measurement is a necessity in pain treatment but can be difficult in young children. The aim of this study was to evaluate the validity and reliability of the Behavioural Observational Pain Scale (BOPS) as a postoperative pain measurement scale for children aged 1-7 yrs. The scale assesses three elements of pain behaviors: facial expression, verbalization, and body position. Design: A prospective study. Setting. A day surgery care unit for children and a neurosurgical postoperative care unit. Patients: Seventy-six children aged 1-7 yrs (4.5 +/- 1.8) undergoing elective surgical procedures were observed. Interventions. None. Measurements and Main Results. The study was divided into interrater reliability, concurrent validity, and construct validity. The interrater reliabilities of the observers were very good with a high agreement between the different nurses' BOPS scores. Each item of the BOPS scale ranged from kappa(w) 0.86 to 0.95. In the concurrent validity, BOPS and Children's Hospital of Eastern Ontario Pain Scale scores had a positive correlation indicating that both tools described similar behaviors (r(s) =.871, p <.001). In construct validity, the effect of analgesic Was tested before analgesic administration and at 15, 30, and 60 mins after analgesic administration. The differences in BOPS score between the time intervals were significant (p <.01) before administration of analgesia and at 15, 30, and 60 mins. There was also statistical significance in the BOPS score (p <.01) between 15 and 60 mins after administration of analgesia. Conclusions. With BOPS, the caretaker can evaluate and document pain with high reliability and validity and thereby improve postoperative pain treatment in preschool children. The simple scoring system makes BOPS easy to incorporate in a postoperative unit.
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