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Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery

Coble, Janette; Steurer, Lisa M.; Balakas, Karen; Ercole, Patrick M.

Journal of Neuroscience Nursing: December 2019 - Volume 51 - Issue 6 - p 292–296
doi: 10.1097/JNN.0000000000000477

BACKGROUND 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 control.

METHODS 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.

RESULTS 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 = .661).

DISCUSSION 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.

Janette Coble, MA BSN RN CNRN, is Staff Nurse, Neuroscience Unit, St. Louis Children's Hospital, St Louis, MO.

Karen Balakas, PhD RN, was Manager of Research & Outcomes (retired), St. Louis Children's Hospital, St Louis, MO.

Patrick M. Ercole, PhD MPH, is Statistician, Sansom Consulting, Glendale, AZ.

Questions or comments about this article may be directed to Lisa M. Steurer, PhD RN CPNP-PC, at She is Manager of Research & Outcomes, St. Louis Children's Hospital, St Louis, MO.

This work was supported by the St. Louis Children's Hospital Foundation Research Program Enhancements Grant.

The authors declare no conflicts of interest.

© 2019 American Association of Neuroscience Nurses