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To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1744-6155.2007.00109.x Byline: Michelle L. Czarnecki (1), Molly Murphy Garwood (2), Steven J. Weisman (3) Keywords: Advanced practice nurses; after care; controlled-release analgesics; delayed-action preparations; follow-up; oxycodone; oxycodone CR; pain management; pediatric nursing; postoperative pain; spinal fusion; telenursing Abstract: PURPOSE. Children undergoing spinal fusion surgery require sophisticated pain management. This study describes an integrated system of pain management primarily directed by an advanced practice nurse (APN), encompassing both the inpatient and outpatient settings. DESIGN AND METHODS. A retrospective chart review was conducted. Pain management and patient education began in the hospital. The APN provided telephone-based follow-up and management after discharge. RESULTS. An average of four phone calls over 9 days was required per patient. No complications were reported. PRACTICE IMPLICATIONS. Results of this study support the APN telephone management of postoperative pain once children are discharged following extensive surgery. Author Affiliation: (1)Jane B. Petit Pain and Palliative Care Center, Children's Hospital of Wisconsin (2)Anesthesiology and Pediatrics, Medical College of Wisconsin (3)Medical College of Wisconsin and Jane B. Petit Chair in Pain Management, Jane B. Petit Pain and Palliative Care Center, Children's Hospital of Wisconsin, Milwaukee, WI Article History: First received December 1, 2006; Revision received February 20, 2007; Accepted for publication March 18, 2007. Article note: Author contact: mczarnecki@chw.org, with a copy to the Editor: roxie.foster@uchsc.edu

Objectives. The aim of this study was to conduct a randomized, controlled comparison of outcomes associated with parent/nurse-controlled analgesia (PNCA), with and without a basal (background) opioid infusion, with intravenous (IV) opioids intermittently administered by a nurse on an "as needed" basis (IV PRN) for postoperative pain management in children with developmental delay (DD). Methods. Participants included children with DD expected to require IV opioids for at least 24 postoperative hours. Patients were randomized to one of three groups: PNCA with a basal infusion, PNCA without a basal infusion, or IV PRN opioids. Demographics, pain scores, opioid consumption, and frequency of side effects were collected beginning 12hours after emerging from anesthesia to decrease the impact of anesthetic agents on outcomes. Results. The 81 participants (median 5 12.0, 9.0-15.0 years) were primarily Caucasian (74%) males (58%), with severe DD (69%) having spinal surgery (41%). The proportion of patients in each group with pain scores ≤3 vs ≥4 revealed no between-group differences in any epoch (P 5 0.09-0.27). Patients in the PNCA with a basal group consumed significantly more opioid (median 5 0.03mg/kg/h morphine equivalents, 0.02-0.03mg/kg/h) than the PNCA without a basal infusion. No difference was found between the PNCA without a basal (median 5 0.01mg/kg/h morphine equivalents, 0.00-0.02mg/kg/h) and the PRN groups (median 5 0.01mg/kg/h morphine equivalents, 0.01-0.02mg/kg/h). There were no statistically significant differences in side effects, with the exception that more children in the PNCA group required supplemental oxygen (P50.05). Conclusions. Results suggest there may be no advantage to PNCA over PRN opioids in this patient population after the first 12 postoperative hours with regard to pain scores, opioid consumption, or side effects. [ABSTRACT FROM AUTHOR]

Offers information on a study on the benefits and potential risks of nasal pharyngeal (NP) suctioning of infants with respiratory illnesses. Purpose of the study; Methods; Results of the study.