POSTOPERATIVE SYMPTOMS AT HOME FOLLOWING DAY-CASE SURGERY IN CHILDREN- A MULTICENTER SURVEY OF 551 CHILDREN

The incidence and duration of postoperative symptoms in children at ho me following day-case anaesthesia and surgery was evaluated using a qu estionnaire completed by parents of 551 children aged 4 months to 13.4 years (mean 3.8 years). They also evaluated the instructions given in hospital for care at home. The incidence of all symptoms was highest at home on the day of the operation. No postoperative symptoms were re ported in 79 (14%) children. The incidence of pain was 56% and the onl y significant predictor was the type of operation, tonsillectomy being the most problematic (mild pain in 38% and severe in 25%; pain lasted 7 days or longer in 33%). Analgesics were given to 78% of all the chi ldren reported to have pain on the day of the operation, to 60% the ne xt day and later to 58%; 19 (3%) children were given more than two dos es per day. The instructions given in hospital for the treatment of pa in were considered inadequate by 12% of parents. Postoperative nausea and vomiting occurred in 13% of children. Predictors by multiple stepw ise logistic regression analysis were emetic symptoms in hospital, pai n at home, age >5 years and administration of postoperative opioid (pe thidine or fentanyl). Opioid given during anaesthesia (fentanyl or alf entanil) did not increase the incidence. Emetic symptoms were most com mon after tonsillectomy (31%). The highest incidences of emetic sympto ms (37%), sedation (96%) and dizziness (41%) occurred in children who had been given fentanyl for postoperative pain. Undertreatment of naus ea in hospital was evident as only two children had received anti-emet ics, even though 61 were reported to have emetic symptoms. Administrat ion of effective anti-emetics should be encouraged, as emetic symptoms in hospital were the most significant predictor of nausea and vomitin g at home. Treatment of pain at home and instructions for treatment of pain need to be improved.