CLINICAL ISSUES Pain assessment and management practices in children following surgery of the lower limb Jaga Maya Shrestha-Ranjit* and Elizabeth Manias Aims. To examine paediatric nurses’ pain assessment and management practices in relation to postoperative care for children following surgery of a fractured lower limb and to compare these practices with evidence-based guidelines. Background. Managing pain is one of the most challenging issues in current paediatric practice. The incidence of lower limb fractures is high in children, which often leads to pain and related complications in the postoperative period. Design. A retrospective clinical audit study. Methods. A retrospective audit of all medical records (n = 106) was undertaken over two years of children aged 5–15 years who were admitted for surgical procedure for a fractured lower limb. An audit tool was developed to collect data related to children’s postoperative pain assessment and management on the day of operation to the third postoperative day. The study was undertaken in a tertiary paediatric hospital in Australia. Results. The retrospective audit revealed that assessment and management of children’s postoperative pain was inadequate. On average, 75% of children experienced some degree of pain; 50% had moderate to severe pain. Nurses assessed pain less frequently compared to the number of times they were expected to assess pain postoperatively. Most analgesics were prescribed on an ‘as needed’ basis and patients received significantly lower amounts of analgesics than prescribed amounts. Conclusion. The clinical audit revealed that addressing children’s postoperative analgesic needs was not consistent with evidence-based guidelines. Relevance to clinical practice. While this study was undertaken in only one hospital, the results are likely to be applicable to other children’s hospital settings. Nurses need to be proactive in promoting effective assessment and management of pain in children. The results of this study provide a useful guide for planning and implementing future strategies to improve postop- erative pain management in children. Key words: analgesics, children, fracture, nursing, pain assessment, pain management Accepted for publication: 24 June 2009 Introduction Although major advances have led to improved management of acute pain, postoperative pain is inadequately treated in children, and a large proportion of children experience moderate to severe pain following surgery (Field 1996, Kart et al. 1996, Gauthier et al. 1998, Helgadottir 2000, McClain 2002, O’Donnel et al. 2002, Vincent & Denyes 2004). Under-treatment of children’s pain is associated with mis- conceptions among health professionals, such as children’s experience of pain being less severe than that of adults (Carter 1994, McKenzie et al. 1997). Effective treatment of Authors: Jaga Maya Shrestha-Ranjit, RN, Cert Tertiary Teaching, Cert Culture, PGDipN Child Health, MN Child Health, Lecturer, Auckland University of Technology, School of Health Care Practices, New Zealand; Elizabeth Manias, RN, Cert CritCare, BPharm, MPharm, MNStud, PhD, FRCN, MPS, Professor, The University of Melbourne, School of Nursing and Social Work, Melbourne, Australia Correspondence: Jaga Maya Shrestha-Ranjit, Lecturer, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand. Telephone: +64 9 921 9999; Ext. 7657. E-mail: jagamaya.shrestha@aut.ac.nz *Ms. Jaga Maya Shrestha-Ranjit was formerly at The University of Melbourne, where the work was carried out. 118 Ó 2010 The Authors. Journal compilation Ó 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 118–128 doi: 10.1111/j.1365-2702.2009.03068.x