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© 2015 Society of Urologic Nurses and Associates
Merkel, S.I., Danaher, J.A., & Williams, J. (2015). Pain management in the postoperative pediatric urologic patient. Urologic Nursing, 35(2), 75-81, 100. doi:10.7257/1053-816X.2015.35.1.75
Optimizing pain management is a component of enhanced perioperative recovery for children undergoing urologic surgery. Incisional pain and discomfort from bladder spasms are two types of pain associated with bladder surgery. A child's developmental level and verbal skills must be considered when selecting pain assessment tools. Assessing pain location, type, and intensity is essential in developing a multimodal plan of care for post-operative pain. Pharmacological interventions provide effective pain management, which facilitates early ambulation, return to oral intake, and recovery. Pre-operative preparation, non-pharmacological interventions, and parental presence help decrease anxiety and promote comfort, as well as support a child's coping skills.
Key Words: Pain management, pediatrics, urological surgery, multimodal therapy.
Objectives:
1. Explain the appropriate pain assessment tools nurses can use to assess children's pain coping skills following surgery.
2. List the types of pain experienced in the pediatric post-operative urologic patient.
3. Identify the components of a multimodal pain management plan.
4. Describe the benefits of effective pain management in the pediatric urologic post-operative patient.
Effective post-operative pain management for the pediatric urologic patient undergoing surgery is an essential part of enhanced perioperative recovery and urologic nursing care. Using evidencebased interventions, such as preoperative preparation, fluid management, minimally invasive surgery, nutrition, and early ambulation, will help achieve the goal of reducing perioperative stress and facilitating the patient's recovery (Brodner et al., 2011; Carli et al., 2011; Kehlet & Wilmore, 2008). Multimodal pain management optimizes pain relief and promotes early mobilization, a prerequisite for the patient's enhanced recovery.
Once pain is identified or anticipated, a multimodal treatment plan is established, sparing the use of opioids as much as possible, to minimize or eliminate common opiod side effects, such as nausea, vomiting, constipation, and sedation (Hedman & Palmer, 2009). This article will 1) describe the nature of pain and the elements of a quality pain assessment in the pediatric patient, 2) identify the types of pain experienced post-operatively, and 3) describe a multimodal pain management plan of care for a child undergoing urologic surgery.
Nature of Pain
Children undergoing urologic surgery can experience a wide...