HOME CARE MANAGEMENT OF PEDIATRIC PAIN

描述：儿科外科门诊人数广泛增长。 在最近几年。扁桃体切除术，最流行的非卧床手术之一 在儿童中，一直与相当程度的术后相关 发病率低，疼痛控制不足是一个主要问题。因此， 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)止痛药剂量和护士培训， 旨在减少家庭有效控制疼痛的障碍)， 标准护理(即常规的父母术后教育)和 需要“止痛剂剂量，或标准护理和ATC剂量。患者(N=300) 将从一个大型门诊手术项目中招募，并将 随机分为三个治疗组之一。标准护理中的父母 小组将接受常规的术后教育，并将被告知 根据需要每4小时给孩子服用一次止痛药(组 A)，或每隔4小时ATC(B组)。结构化疼痛管理中的家长 小组(C组)将接受包括标准 术后指导和疼痛管理教育有针对性地增加 将知识和减少有效疼痛管理的障碍作为 教练干预，威尔被告知每四天服用一次止痛药 ATC小时数。三个小组的家长都将在以下时间收到后续电话 术后第1天和第2天。在标准护理小组中， 电话将通过完成以下工作来确定遵守程度 每日日志。参加结构化疼痛管理小组的家长将收到 在电话中进行指导，包括回顾疼痛评分，孩子 坚持吃止痛药，止痛药的策略 管理(如图所示)、ATC剂量的基本原理和ATC的说明 剂量和潜在的副作用。患者将接受为期三天的跟踪调查 扁桃体切除术后的夜晚和父母将在 早上和晚上。这项研究的主要结果变量是： 吞咽和不吞咽、服用止痛剂、口服时的疼痛强度评分 摄入液体、不良行为和副作用。患者和父母在 所有疼痛管理小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历。

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.