Pain management in children with and without cognitive impairment following spine fusion surgery

Background: We compared pain assessment and management practices in childre n with and without cognitive impairment (CI) undergoing spine fusion surger y. Methods: The medical records of 42 children (19 with CI and 23 without) wer e reviewed and data related to demographics, surgery, pain assessment and m anagement, and side-effects were recorded. Results: Fewer children with CI were assessed for pain on postoperative day s (POD) 0-4 compared to those without CI (P < 0.002). Self-report was used for 81% of pain assessments in children without CI, while a behavioural too l was used for 75% of assessments in cognitively impaired children. Childre n with CI received smaller total opioid doses on POD 1-3 compared to those without CI (P <less than or equal to> 0.02). Furthermore, children without CI received patient/nurse-controlled analgesia for more postoperative days than children with CI (P = 0.02). Conclusions: Our data demonstrate a discrepancy in pain management practice s in children with and without CI following spine fusion.