Pediatric Pain Assessment at Recovery Room in Srinagarind Hospital

Background : Acute pain is a common postoperative problem, especially among pediatric patients (between 1 and 6 years of age). Since children cannot report their pain to health care providers, pain needs to be promptly assessed as untreated pain may lead to sustained changes in the central neural system. Behaviour is also a useful measure and indicator of pain in children. In the Post Anesthetic Care Unit (PACU) at Srinagarind Hospital, the Face, Legs, Activities, Cry, Consolability (FLACC) scale is used for pain assessment. Objectives : To determine the proportion of pediatric patients who have undergone the FLACC pain assessment scale in the PACU and the correlation between FLACC scale and treatment. Design : Retrospective descriptive study Setting : PACU, Department of Anesthesiology, Srinagarind Hospital, Khon Kaen University Materials & method : 180 pediatric (under 6 years of age) patients’ records in the PACU were reviewed since June 2005. Outcome measurements including sex, age, ASA status, type of operation and procedure, type of pain assessment, number of FLACC scale (0-10) used for pain assessment, causes of non-assessment and number of assessment were recorded. The results were analyzed using descriptive statistics and presented as means and percentages. Results : Among the 180 pediatric patients, 65% were male and 34% were in middle childhood. 67% of pediatric patients in the PACU were assessed by FLACC pain scale. Almost all nurses (98%) used FLACC scale to assess pain in their pediatric patients. It was found that patients’ sleep (46%) at the time of admission to the PACU was the common cause of non-assessment. In term of pain treatment, 61% of the patients were assessed for their pain before treatment, however 21% of the patients having pain (FLACC>2) did not receive any pain treatment. The most common cause (89%) of non-assessment was due to patients’ crying. The mean of FLACC scale before and after treatment were 3.64 + 6.25 and 3.27 + 8.26, respectively. Conclusion : The pediatric pain assessment was used in the PACU more frequently than previously surveyed; however the use rate was not 100% (as expected) and some of patients having pain (FLACC>2) did not receive any treatment. As a result, education and personnel support might be useful in order to improve the quality of pain assessment and treatment in the PACU. Key words : Pediatric pain assessment, FLACC scale, PACU