HOME CARE MANAGEMENT OF PEDIATRIC PAIN

描述：小儿外科门诊人数广泛增长 近年来扁桃体切除术，最流行的门诊手术之一 在儿童中，与相当程度的术后 发病率，疼痛控制不足被列为主要问题。因此，我们认为， 这项随机临床试验将比较结构化的 疼痛管理计划（即，结合常规父母术后 教育，全天候（ATC）镇痛剂给药和护士指导， 其目标是减少家庭中有效疼痛控制的障碍）， 采用标准护理（即常规父母术后教育）和“作为 需要”镇痛剂给药，或标准护理和ATC给药。患者（N = 300） 将从一个大型门诊手术项目中招募， 随机分配至三个治疗组之一。标准护理中的父母 各组将接受常规术后教育，并被告知 根据需要每4小时给孩子服用一次止痛药（组 A），或每4小时ATC（B组）。父母在结构性疼痛管理 组（C组）将接受教育会议，包括标准 术后指导和疼痛管理教育旨在增加 知识和减少有效疼痛管理的障碍， 教练干预，并将被告知每四次服用止痛药 小时ATC。所有三组的家长都将接到后续电话， 术后第1天和第2天。在标准护理组中， 电话将是为了确定与完成的遵守程度， 每日日志结构化疼痛管理组的父母将获得 在电话中进行指导，包括审查疼痛评分，儿童 坚持服用止痛药，止痛药的策略 给药（如适应症）、ATC给药依据和ATC说明 剂量和潜在的副作用患者将被随访三天 扁桃体切除术后的夜晚，父母将在 早上和晚上。本研究的主要结局变量为： 有和无吞咽、镇痛剂消耗、口服的疼痛强度评分 摄入液体，负面行为和副作用。患者和家长在 所有疼痛管理组将在研究结束时进行访谈，以描述 他们在这个项目上的经验。

DESCRIPTION: The pediatric surgery outpatient population has grown extensively in recent years. Tonsillectomy, one of the most prevalent ambulatory surgeries in children, has been associated with a substantial degree of postoperative morbidity, with inadequate pain control cited as a major concern. Therefore, this randomized clinical trial will compare the effectiveness of a structured pain management program (i.e. that combines routine parent postoperative education, with around the clock (ATC) dosing of analgesics and nurse coaching, that is targeted at decreasing barriers to effective pain control in the home), with either standard care (i.e. routine parent postoperative education) and "as needed" analgesic dosing, or standard care and ATC dosing. Patients (N = 300) will be recruited from a large ambulatory surgery program and will be randomized to one of three treatment groups. Parents in the standard care groups will receive routine postoperative education and will be told to administer pain medication to their children every 4 hours "as needed" (Group A), or every 4 hours ATC (Group B). Parents in the structured pain management group (Group C) will receive and educational session that includes standard postoperative instructions and pain management education targeted at increasing knowledge and decreasing barriers to effective pain management as part of a coaching intervention, and will told to administer pain medication every four hours ATC. Parents in all three groups will receive follow-up phone calls on days 1 and 2 following surgery. In the standard care groups, the purpose of the phone calls will be to ascertain level of adherence with completion of the daily logs. Parents in the structured pain management group will receive coaching during the phone calls to include review of pain scores, child adherence to taking pain medicine, strategies for pain medication administration (as indicated), rationale for ATC dosing and instruction for ATC dosing, and potential side effects. Patients will be followed for three days and nights following tonsillectomy and parents will complete diaries in the morning and in the evening. The major outcome variables for this study are: pain intensity scores with and without swallowing, analgesic consumption, oral intake of fluids, negative behaviors and side effects. Patients and parents in all pain management groups will have and end of study interview to describe their experiences with the program.