Aims Can an automated texting system be used to gather data about analgesia usage after discharge and post-operative pain scores?
Our opioid analgesic for post-operative pain control had changed from codeine to morphine two years earlier.
Was this dosing and supply adequate or excessive and how could we assess pain control for patients at home? Some surgeons described their technique as ‘relatively painless’ and had as a consequence chosen to stop prescribing any opioid after surgery.
Previous audits by post or telephone had achieved a 40% response rate at best. Could we use the smart ‘phones that all parents carry around instead?
Methods We recruited patients undergoing tonsillectomy ± adenoidectomy, and recorded their age, weight, gender, diagnostic indication for surgery and surgical technique.
After overcoming a few IT challenges and with written consent, parents were texted a series of questions for 10 evenings postoperatively, starting the day following surgery.
Questions (requiring a single digit response) included the maximum pain score (0–10) experienced, the analgesic drugs administered and any nausea or vomiting (PONV) experienced that day. Responses were stored in a secure database for analysis.
Results 33 patients were recruited with1 surgical cancellation. 27/32 (84%) parents responded to texts on ≥5 days.2 Patients with poor responses were excluded.
Of the 30 studied, 50% were male, with age range 10 months to 15 years, and weight range 6.6 kg to 64 kg. 21 patients had sleep-disordered breathing (SDB) and 14 patients had experienced recurrent tonsillitis, including 5 who also had SDB.
All children had paracetamol and ibuprofen available, but 4 patients were discharged without morphine. The average pain score ranged from 4.0 on Day 1 to a peak of 5.5 on Day 6 to a minimum of 2 on Day 10.
In total, 69.2% parents gave their children morphine on one or more days in addition to simple analgesia. The rate of PONV was 30%, unrelated to morphine use.
Conclusion SMS proved very successful for data collection and has great potential for further audit studies.
Our data shows that pain is a significant problem for up to 10 days post-tonsillectomy and has confirmed the requirement for opioid rescue medication for all patients after discharge.
We have now re-agreed a standard analgesic regime and staved off any suggestion there was just to recommend that parents buy analgesia.
Williams G, et al. The prevalence of pain at home and its consequences in children following two types of short stay surgery: A multicentre observational cohort study. Paediatric Anaesthesia 2015;25:1254–1263.
Association of Paediatric Anaesthetists of Great Britain and Ireland. Guidance for the administration of codeine and alternative opioid analgesics in children Nov 2013.
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