Postoperative Pain Management & Prevention of Complications in the Pediatric Surgical Patient
Bertozzi, Sophia and Walsh, Andrew
Conway School of Nursing, NURS481 Practicum
Pathogenesis of Pain, Dinakar, P., & Stillman, A. M. (2016). Pathogenesis of Pain. Seminars in Pediatric Neurology, 23(3), 201–208. https://doi.org/10.1016/j.spen.2016.10.003
Multimodal Pain Management
- Consistent, situation-appropriate assessment is key!
- Scheduled multimodal non-opioid analgesia (acetaminophen or NSAIDs) rather than PRN-only dosing to maintain consistent pain control and reduce opioid requirements.
- Reserve opioids for breath-through pain to minimize risks of respiratory depression, over- sedation, and decreased oxygen saturation.
- Promoting atraumatic care leads to greater pt/family satisfaction and better clinical outcomes.
Preventing Pulmonary Complications
- Implement scheduled respiratory support strategies to prevent atelectasis and opioid-related respiratory depression (incentive spirometry, positioning, early ambulation/mobilization).
- Encourage age-appropriate deep breathing techniques to promote lung expansion and prevent atelectasis (bubbles, pinwheel, incentive spirometer).
- Maintain upright positioning and early ambulation as tolerated to improve ventilation.
Holistic Interventions
- Family collaboration/education supports faster recovery and less pain both in hospital & at discharge.
- Nonpharmacological strategies (especially in collaboration with Child Life Specialists) enhance effectiveness of pharmacological interventions.
References
Hosseini, Z., Valizadeh, F., Nikfarid, L., Mohammadi, R., & Ghasemi, S. F. (2025). Effectiveness of Human Caring Theory–Based Nursing Interventions on Pediatrics Postoperative Pain. Pain Management Nursing. https://doi.org/10.1016/j.pmn.2025.10.014
Hougaard, P. F., & Smeland, A. H. (2025). Barriers to Pediatric Postoperative Pain Management—Interprofessional Focus Group Interviews. Pain Management Nursing, 26(2), e117–e123. https://doi.org/10.1016/j.pmn.2024.11.001
Kim, H., et al. (2025). Acute postoperative pain control in pediatric patients: A scoping review. National Institutes of Health (NIH). https://pmc.ncbi.nlm.nih.gov/articles/PMC12887120/
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., Wilson, D., Alden, K. R., Cashion, K., & Olshansky, E. F. (2023). Maternal child nursing care (7th ed.). Elsevier.
University of Pittsburgh Medical Center. (2025). Multimodal analgesia for pediatric postoperative pain management. https://cce.upmc.com/content/multimodal-analgesia-pediatric-postoperative-pain-management
- Surgical tissue injury triggers the release of inflammatory mediators such as prostaglandins and cytokines that activate peripheral nociceptors being transmitted to the CNS. Pain perception is influenced by developmental stage, anxiety, and prior experiences. Inadequate pain control leads to sympathetic NS activation, resulting in increased HR, BP, and O2 demand.
- In peds patients, untreated pain can impair respiratory function by limiting deep breathing and effective coughing, increasing the risk of atelectasis and other pulmonary complications. Conversely, excessive use of opioids can cause respiratory depression due to increased sensitivity in children, particularly in the immediate postoperative period due to sedation meds.
- Effective postop pain management: balance between pain control and respiratory function, with consideration of psychological and developmental factors that influence pain perception and response.
Case 1: Sophia’s Patient in PACU
- Prominent Health History: 16-month-old female born at 36 weeks gestation; history of congenital anorectal/urogenital malformation, status post complex reconstructive surgery and congenital renal hypodysplasia; NKA.
- Clinical Presentation/Situation: Postoperative pain with intermittent agitation (inconsolable cry, rigid kicking/jerking 🡪 10/10 on FLACC immediately post-op); episodes of decreased respiratory rate and O2 sat following prn opioid administration; pt unable to receive NSAIDs due to renal impairment; caregiver hesitancy toward non-opioid analgesics influenced pain management approach.
- Key Assessments: q5 min FLACC Scale pain assessment due to age and sedation; continuous monitoring of respiratory status (WOB, pulse oximetry) and sedation level.
- Key Interventions: Scheduled administration of acetaminophen, titration of PRN opioid analgesia with close respiratory monitoring; caregiver education provided on multimodal pain management, medication safety, wound care, hygiene, and postoperative expectations prior to transfer to SCU.
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Case 2: Andrew’s Patient on SCU
- Prominent Health History: 8-year-old male with history of mild asthma, otherwise healthy; admitted for acute appendicitis status post laparoscopic appendectomy; NKA.
- Clinical Presentation/Situation: Postoperative day 1 on SCU with reports of moderate abdominal pain rating 6/10 using Wong-Baker faces pain scale, shallow respirations, and reluctance to ambulate due to pain. Intermittent desaturation to 92% on room air noted during rest due to shallow respirations.
- Key Assessments: q4hr pain assessment using Wong-Baker FACES scale; continuous pulse oximetry; respiratory assessment of rate, depth, effort, lung sounds; monitoring for signs of atelectasis such as diminished breath sounds and low-grade fever; evaluation of mobility status and bowel function.
- Key Interventions: Scheduled administration of acetaminophen and NSAIDs with PRN opioid for breakthrough pain; implementation of nonpharmacologic pain management such as splinting incision, distraction, caregiver involvement; encouragement of incentive spirometry and bubbles every 1–2 hours while awake; early ambulation with assistance; caregiver education on importance of pain control for respiratory function and recovery.
Pediatric Pain Assessment Tools, Merkel, S. I., Voepel-Lewis, T., Shayevitz, J. R., & Malviya, S. (1997). The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatric Nursing, 23(3), 293–297.