LAUSR

The accompanying article by Cai and colleagues in this edition of The Journal of Clinical Anesthesia characterizes factors that influence postoperative pain in 204 healthy preschool age children during the first two weeks following outpatient surgery. [1] Postoperative pain management is a complex and challenging issue in pediatrics, especially with regard to ambulatory surgery. The authors, in their prospective study, explored the impact of various demographic, intra-operative, and parental factors on both pain and behavior-related outcomes in young children undergoing outpatient surgical procedures. In recent years, we have seen a surge in efforts to streamline postoperative care in ambulatory surgical patients; the authors' data contribute to this mission and pave the road to developing novel strategies to improve postoperative pain management in this setting. The majority of the patients in the authors' cohort experienced pain early on following discharge, mostly resolving by 1–2 weeks. This finding reflects prior data but at significantly lower rates. [2,3] The authors attribute this discrepancy to refinements in analgesic strategies (e.g., regional anesthesia andmultimodal analgesia) as well as implementation of newer and potentially less painful surgical techniques. This is the first study in the pediatric ambulatory setting to evaluate intraoperative medication administration and its effect on postoperative pain. The authors found that postoperative pain scores were unaffected by administration of specific medications; of note, data on the use of regional anesthetics were not included in their analysis, likely because of their cohort's diverse case range, which included orthopedic, urological, general surgical, and otolaryngology procedures. Given recent increases in popularity of pediatric regional anesthesia, further information on patient subsets may provide additional insights to improve analgesic strategies. Parents assume primary responsibility for managing their child's post-operative discomfort. This is especially true for younger children, whomay beunable to adequately express their pain. Poor postoperative pain control in this age group is associatedwithmaladaptive behavioral changes with the potential for long-term cognitive and emotional sequela. [4] The authors noted an increased level of pain in children whose parents were compliant with discharge pain medication administration instructions when compared to children who were not prescribed any pain medications. They attributed this finding to proper identification of children who were more likely to experience pain in the postoperative period. Interestingly, prior research has shown that parents often underestimate their children's pain and that parental ratings of pain show poor levels of agreement with their children's self-reports, potentially resulting in undermedication. [5] Finley et al. found that 60–75% of children judged to be experiencing clinically significant