4P: Persistent Postoperative Pediatric Pain

Study Overview
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Brief Summary
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For children, adequate perioperative pain management is a right according to the UN convention on the rights of the child, a law in Sweden since 2020. Despite this, children are still under-treated in many cases. In addition to great suffering, this can lead to missing school and a long-term burden on the society. ESPA, the European Society for Pediatric Anesthesia, has drawn up guidelines for perioperative pain management. With the study 4P: Persistent Postoperative Pediatric Pain, we want to investigate whether these guidelines are followed and how many children develop long-term pain postoperatively. In order to map the prevalence of pain after surgery in children in Sweden, the investigators plan to include and follow 2000 children in southern Sweden who undergo surgery. The study provides a unique opportunity to follow a large number of children, evaluate given per- and postoperative pain treatment and identify factors linked to the development of acute and long-term postoperative pain. Our goal is to optimize peri- and postoperative pediatric pain management to promote rapid recovery after surgery.

Official Title
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4P: Persistent Postoperative Pediatric Pain

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: Scheduled surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 1-17 years Scheduled surgery for hernia, penile surgery, retentio testis, adenotonsillectomy, appendectomy or acute fracture in southern Sweden. Informed consent Exclusion Criteria: Scheduled for several surgeries within the time-frame Inability to understand swedish Inability to understand the meaning of participation.

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Scheduled surgery|All subjects will be exposed to surgery|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of acute postoperative pain | How many children experience acute postoperative pain after surgery in Sweden? | Within 24 hours after surgery | 
| Adherence to guidelines from ESPA regarding perioperative analgesia | How many patients are treated according to the suggested guidelines regarding pain treatment from ESPA (%)? Do they experience less postoperative pain (FLACC/FPS/NRS 0-10)? Groups compared with MannWhitney U-test. Also description of the deviation. | Perioperative | 
| Incidence of persistent postoperative pain | How many children experience persistent postoperative pain after surgery in Sweden? | At 3 months after surgery | 
| Incidence of persistent postoperative pain | How many children experience persistent postoperative pain after surgery in Sweden? | At 6 months after surgery | 
| Incidence of persistent postoperative pain | How many children experience persistent postoperative pain after surgery in Sweden? | At 1 year after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Do regional blocks influence the level of acute postoperative pain? | Do children who recieve a regional block experience less postoperative pain? Croups compared with MannWhitney U-test. | Acute - within 24 hours. | 
| Do regional blocks influence the level of persistent pain? | Do children who recieve a regional block experience less postoperative pain? Croups compared with MannWhitney U-test. | 3 months after surgery | 
| Parental stress | Does the subjective level of stress, measured on a scale from 0-10 by the parents, affect the experience of acute postoperative pain? Correlation between pain (FLACC/FPS/NRS depending on age) correlated to subjective stress using Spearman Rho. | Within 24 hours | 
| Parental stress | Does the subjective level of stress, measured on a scale from 0-10 by the parents, affect the experience of persistent postoperative pain? Correlation between pain (FLACC/FPS/NRS depending on age) correlated to subjective stress using Spearman Rho. | 3 months after surgery | 
| Age | Which age-groups experience most pain. Pain evaluated with FLACC/FPS/NRS depending on age. Risk evaluated with logistic regression. | Acute (24 hours) and persistent (3,6 months and 1 year) | 
| Gender | Do girls experience more pain than boys? Pain evaluated with FLACC/FPS/NRS depending on age. Risk evaluated with logistic regression. | Acute (24 hours) and persistent (3,6 months and 1 year) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pediatric pain