• Yi Cai, Lindsay Lopata, Arthur Roh, Mary Huang, Matthew A Monteleone, Shuang Wang, and Lena S Sun.
• Department of Anesthesiology, Columbia University, 622 West 168th Street, New York, NY 10032, United States.
• J Clin Anesth. 2017 Jun 1; 39: 100-104.

Study ObjectiveTo identify demographic, intraoperative, and parental factors that influence the postoperative pain experience in ambulatory surgery pediatric patients. We also monitored postoperative maladaptive behavior changes (PMBCs) to investigate the relationship between pain and PMBCs.DesignProspective cohort study.SettingDischarge period after ambulatory surgery.Patients204 patients ages 1-6years undergoing ambulatory orthopedic, urology, general surgery, and otolaryngology surgical procedures who were American Society of Anesthesiologists (ASA) physical status I or II.InterventionsNone.MeasurementsWe administered telephone questionnaires to parents of ambulatory surgery patients 1-6years old exploring pain ratings, behavior change ratings, and medication compliance at 2-3days and 1-2weeks after surgery. Pain and behavioral change scores were obtained using the Parents Postoperative Pain Measure (PPPM) and Post-Hospital Behavior Questionnaire (PHBQ). Parental medication compliance was defined as parents who followed the discharge instructions for pain medication administration.Main ResultsFor our cohort, 69% of patients experienced pain after 2-3days and 17% after 1-2weeks post-discharge. PMBCs were reported in 55% after 2-3days, and in 15% after 1-2weeks. In addition, PMBCs occurred in the absence of pain (PPPM=0) at rates of 20% and 5% at 2-3days and 1-2weeks after surgery, respectively. Female sex, anesthesia duration, and otolaryngology procedures correlated with higher postoperative pain (PPPM) scores in univariate and multivariate analysis. Intraoperative medications did not correlate with PPPM or PHBQ scores. Higher pain scores were associated with parents who were compliant with discharge instructions for pain medications.ConclusionsMany pediatric patients experienced short-term pain and PMBCs after ambulatory surgery, but these largely resolved by 1-2weeks following discharge. Patient sex, anesthesia duration, and surgical procedure influenced postoperative pain and/or PMBCs. Furthermore, PMBCs were associated with, but not solely a manifestation of, postoperative pain.Copyright © 2017. Published by Elsevier Inc.

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