Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

Dana B. Gal, Caitlin O. Clyde, Erin L. Colvin, Jessica Colyer, Anne M. Ferris, Mayte I. Figueroa, Brittney K. Hills, Sarah M. Lagergren, Jordan Mangum, Jessica L. Mann, Angela S. McKeta, Sonali S. Patel, Jennifer F. Reeves, Molly Richter, Lisa M. Ring, Joshua M. Rosenblum, Kaitlin Tindel, Jeffrey G. Weiner, Kimberly G. Williams, Luis M. ZabalaNicolas L. Madsen

Research output: Contribution to journalReview articlepeer-review


BACKGROUND: Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline. METHODS: A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus. RESULTS: 60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations. CONCLUSIONS: Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.

Original languageEnglish (US)
Pages (from-to)1881-1893
Number of pages13
JournalCardiology in the Young
Issue number12
StatePublished - Dec 1 2022


  • CHD
  • Clinical practice guideline
  • postoperative pain

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine


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