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 journalArticlepeer-review

2 Scopus citations


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 languageEnglish (US)
Pages (from-to)1206-1212
Number of pages7
JournalJournal of pediatric surgery
Issue number6
StatePublished - Jun 2023


  • 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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