Documentation of postoperative pain in the neonatal brachial plexus palsy population

Aims and objectives. To assess postoperative pain management in neonatal brachial plexus palsy children who underwent a primary nerve repair, release only and/or a release and transfer procedure. Background. Previous studies have noted pain management inadequacies in postoperative pain management in certain paediatric populations. However, this is the first study to focus on postoperative pain management in this particular population. Methods. Seventy-five patients, who underwent a primary nerve repair, release only and/or a release and transfer procedures at our institution, were reviewed. Postoperative pain management was assessed on a patient and drug administration level through appropriate pain scale use; appropriate dosage for the medication prescribed; appropriate reassessment of pain following medication administration; and complications leading to a longer hospital stay. Results. Based on our institution's guidelines following drug administration, 64 patients were not appropriately reassessed for pain. Based on the drug's duration following drug administration, 40 patients were not appropriately reassessed for pain. Twenty-eight per cent of all medication administrations were not properly reassessed for pain based on the drug's duration and 62% of the time based on our institution's guidelines. Fifty per cent of all medication administrations were not properly dosed and 51 patients were not appropriately dosed at least once during their hospital stay. Pain scales were documented incorrectly 20% of the time and administered improperly to 13 patients. Conclusions. Opportunities for improvement in postoperative pain management in the paediatric population - particularly those with neonatal brachial plexus palsy - exist. Relevance to clinical practice. Findings from this study demonstrate that healthcare professionals may have (1) insufficient knowledge regarding pain and/or (2) inadequate direction and guidance to appropriately assess and document pain in the paediatric population. Improvements for these individual healthcare professionals and clinical settings are needed to overcome postoperative pain management issues in the future.