A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain
control. Multiple methods to address pain
post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain
management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain
control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain
A retrospective cohort design was used to compare pain
medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain
. Descriptive and univariate statistics were used to detect differences.
The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain
between the 2 groups (P
Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain
control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain
management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.