Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

Gwyneth A. Sullivan; Lynn Wei Huang; Willemijn L.A. Schäfer; Yao Tian; Audra J. Reiter; Bonnie Essner; Andrew Hu; Martha C. Ingram; Salva Balbale; Julie K. Johnson; Jane L. Holl; Mehul V. Raval

doi:10.1016/j.jpedsurg.2023.02.028

Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

Gwyneth A. Sullivan^*, Lynn Wei Huang, Willemijn L.A. Schäfer, Yao Tian, Audra J. Reiter, Bonnie Essner, Andrew Hu, Martha C. Ingram, Salva Balbale, Julie K. Johnson, Jane L. Holl, Mehul V. Raval

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Introduction: Our aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs). Methods: Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models. Results: Among 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL. Conclusion: Use of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children. Level of evidence: III.

Original language	English (US)
Pages (from-to)	1206-1212
Number of pages	7
Journal	Journal of pediatric surgery
Volume	58
Issue number	6
DOIs	https://doi.org/10.1016/j.jpedsurg.2023.02.028
State	Published - Jun 2023

Funding

Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number R01HD099344. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

Biobehavioral techniques
Children
Gastrointestinal surgery
Multimodal pain control
Patient-reported outcomes
Pediatric

ASJC Scopus subject areas

Surgery
Pediatrics, Perinatology, and Child Health

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10.1016/j.jpedsurg.2023.02.028

Cite this

Sullivan, G. A., Huang, L. W., Schäfer, W. L. A., Tian, Y., Reiter, A. J., Essner, B., Hu, A., Ingram, M. C., Balbale, S., Johnson, J. K., Holl, J. L., & Raval, M. V. (2023). Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery. Journal of pediatric surgery, 58(6), 1206-1212. https://doi.org/10.1016/j.jpedsurg.2023.02.028

@article{258932b2e6d74f678a8660d7de875916,

title = "Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery",

abstract = "Introduction: Our aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs). Methods: Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models. Results: Among 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL. Conclusion: Use of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children. Level of evidence: III.",

keywords = "Biobehavioral techniques, Children, Gastrointestinal surgery, Multimodal pain control, Patient-reported outcomes, Pediatric",

author = "Sullivan, {Gwyneth A.} and Huang, {Lynn Wei} and Sch{\"a}fer, {Willemijn L.A.} and Yao Tian and Reiter, {Audra J.} and Bonnie Essner and Andrew Hu and Ingram, {Martha C.} and Salva Balbale and Johnson, {Julie K.} and Holl, {Jane L.} and Raval, {Mehul V.}",

note = "Funding Information: Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number R01HD099344. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2023 Elsevier Inc.",

year = "2023",

month = jun,

doi = "10.1016/j.jpedsurg.2023.02.028",

language = "English (US)",

volume = "58",

pages = "1206--1212",

journal = "Journal of pediatric surgery",

issn = "0022-3468",

publisher = "W.B. Saunders",

number = "6",

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TY - JOUR

T1 - Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

AU - Sullivan, Gwyneth A.

AU - Huang, Lynn Wei

AU - Schäfer, Willemijn L.A.

AU - Tian, Yao

AU - Reiter, Audra J.

AU - Essner, Bonnie

AU - Hu, Andrew

AU - Ingram, Martha C.

AU - Balbale, Salva

AU - Johnson, Julie K.

AU - Holl, Jane L.

AU - Raval, Mehul V.

N1 - Funding Information: Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number R01HD099344. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2023 Elsevier Inc.

PY - 2023/6

Y1 - 2023/6

N2 - Introduction: Our aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs). Methods: Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models. Results: Among 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL. Conclusion: Use of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children. Level of evidence: III.

AB - Introduction: Our aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs). Methods: Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models. Results: Among 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL. Conclusion: Use of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children. Level of evidence: III.

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KW - Children

KW - Gastrointestinal surgery

KW - Multimodal pain control

KW - Patient-reported outcomes

KW - Pediatric

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Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

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