Consolability Scale Research Articles

Effectiveness of an External Cooling and Vibrating Device vs Counterstimulation in Reducing Discomfort of Inferior Alveolar Nerve Block in Pediatric Dental Patients: A Single-blinded Randomized Controlled Trial.

Pain management in pediatric patients during dental procedures is very important. Here, the traditional method of behavior management is compared with novel methods. To compare and determine the effectiveness of an external cooling and vibrating device vs counterstimulation with the conventional technique in reducing the fear and discomfort of pediatric dental patients aged 5-7 years during inferior alveolar nerve block (IANB). The study population consisted of children aged 5-7 years, rated as positive (+) or negative (-) on the Frankl behavior rating scale, who reported to the Department of Pediatric and Preventive Dentistry and required dental procedures in posterior teeth that warranted the use of IANB.Anxiety measurement was conducted by both objective and subjective means. The subjective measures included Wong-Baker Faces Pain Rating Scale (WBFPRS), as chosen by the patient, and Face, Legs, Activity, Cry, Consolability Scale (FLACC), as recorded by the observer, while the objective measure was pulse rate, recorded by a pulse oximeter.Group A: External cooling and vibrating device (Buzzy).Group B: Counterstimulation group.Group C: Control group. The WBFPRS score and FLACC score reduced following the intervention in the counterstimulation group, indicating a reduction in pain perception and anxiety compared to the application of Buzzy and the conventional technique. Counterstimulation was the most effective in reducing pain perception and anxiety during the administration of IANB. The injection of local anesthetic remains one of the painful and fear-inducing procedures in pediatric dentistry. This study provides evidence that counterstimulation is effective in reducing pain perception and anxiety during the administration of IANB. Ponnan V, Santhakumar M, Thekke Veetil AK. Effectiveness of an External Cooling and Vibrating Device vs Counterstimulation in Reducing Discomfort of Inferior Alveolar Nerve Block in Pediatric Dental Patients: A Single-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(12):1335-1339.

Comparison between dexmedetomidine and ketofol in the prevention of postoperative emergence delirium in pediatric patients undergoing orofacial cleft surgery: A randomized controlled trial

Abstract Background and Aims: Emergence delirium (ED) is a common postoperative complication in pediatric patients. To avoid postoperative ED, sedative medications have been utilized in addition to general anesthesia. In this study, the primary objective was to assess the incidence of postoperative emergence of delirium at 0-, 10-, 20-, 30-, and 60-min intervals. Secondary objective was to assess postoperative analgesia (0, 10, 20, 30, and 60 min) and hemodynamic parameters (mean arterial pressure, pulse, oxygen saturation). Material and Methods: In this randomized controlled study, 105 American Society of Anesthesiologists I and II patients, aged between 3 months and 2 years, scheduled for orofacial cleft surgery were enrolled. Patients of group I received dexmedetomidine (0.3 μg/kg), group II received ketofol (a mixture of ketamine 0.25 mg/kg and propofol 1.0 mg/kg), and group III received normal saline 10 min before extubation. The incidence of postoperative ED using the Watcha scale and the postoperative pain using the Face, Legs, Activity, Cry, Consolability (FLACC) scale were recorded. Results: The Watcha scale at the immediate postoperative period and at 10-, 20-, 30-, and 60-min intervals was 0 (1), 1 (1.75), 1 (1), 2 (2), and 3 (2) in group I, 1 (1), 2 (1), 2 (2), 2 (3), and 3 (2) in group II, and 2 (1), 3 (1), 3 (1.25), 4 (1), and 4.5 (1.5) in group III, respectively, at the above time points. On comparing group I with groups II and III, the difference was significant (P < 0.01). The FLACC score at the immediate postoperative period and at 10-, 20-, 30-, and 60-min intervals was 1 (1), 1 (1), 1 (1), 2 (2), and 3 (2) in group I, 2 (2), 2 (1), 2 (2), 2(3), and 3 (2) in group II, and 4 (1), 3 (1), 3 (1.25), 4 (1), and 4.5 (1.5) in group III, respectively, at the above time points. The FLACC score was also lower in group I in comparison to groups II and III. The difference among the groups was significant (P < 0.01). The incidence of postoperative delirium was lower in group I at 20% (7/35) than in group II at 29% (10/35) and in group III at 49% (17/35), and difference among the groups was significant (<0.01). Conclusions: We conclude that both dexmedetomidine and ketofol are effective in reducing postoperative ED. Dexmedetomidine is more effective than ketofol in preventing postoperative ED in the pediatric population.

Comparison of caudal bupivacaine and dexmedetomidine with caudal bupivacaine and intravenous dexmedetomidine for postoperative analgesia in children: A randomized controlled trial

Abstract Background and Aims: Caudal block is a part of multimodal analgesic regimen to alleviate pain in pediatric patients undergoing variety of surgeries. This study compares the effectiveness of caudal versus intravenous dexmedetomidine as an additive to caudal bupivacaine for prolonging analgesia in children posted for elective lower abdominal surgeries. The level of sedation and hemodynamic effects through both routes were also compared. Material and Methods: Ninety-six children (aged 1–8 years) of either gender scheduled for elective lower abdominal and pelvic surgeries were prospectively enrolled and randomized into two groups of 48 each: Group A (caudal bupivacaine + caudal dexmedetomidine) and Group B (caudal bupivacaine + intravenous dexmedetomidine). The postoperative pain was monitored using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, and sedation was assessed using the Ramsay sedation scale (RSS). Results: The degree of analgesia was comparable in both groups in the initial hours after surgery. Significantly higher FLACC scores were seen in Group B at 8 h (P- 0.016), 12 h (P < 0.001), and 16 h (P < 0.001), with 89.58% patients needing two rescue analgesic doses. RSS was higher in Gr=oup A till 12 h postsurgery. Conclusion: Caudal dexmedetomidine with bupivacaine provides improved analgesia after 8 h of surgery in comparison to caudal bupivacaine with intravenous dexmedetomidine in children undergoing lower abdominal surgeries.

Can Neutrophil-to-Lymphocyte Ratio, Platelet Volume, and Platelet Distribution Width Be Used as Indicators of Delirium?

Background/Objectives: Postoperative delirium is a frequent complication in children undergoing general anesthesia. It has been suggested that inflammation and oxidative stress contribute to the pathophysiology of delirium. The aim of our study was to investigate the relationship between inflammatory markers and delirium. Methods: A total of 221 children in the ASA 1–3 risk group who underwent adenoidectomy, tonsillectomy, and/or ventilation tube application were included in our single-center, prospective, and observational study approved by the Ethics Committee, numbered E1-23-3197. Patients whose parental consent was obtained were either premedicated with oral midazolam preoperatively or taken to surgery without premedication, depending on the anesthesiologist’s preference. After induction with sevoflurane, rocuronium and fentanyl were administered intravenously. Sevoflurane and infusion of remifentanil were administered for maintenance. At the end of the operation, patients were transferred to the recovery unit and followed up for 30 min. They were evaluated with the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale and Pediatric Anesthesia Emergence Delirium (PAED) Scale. Results: Delirium was observed in 80 patients. There was no significant difference between patients with and without delirium in terms of neutrophil/lymphocyte ratio, mean platelet volume, or platelet distribution volume. Lymphocyte count, PAED score, and FLACC score were statistically higher in patients with delirium (W = 4407.5, p-value = 0.006997; W = 0, p-value < 2.2 × 10−16; W = 9489, p-value < 2.2 × 10−16, respectively). Conclusions: No statistically significant relationship was found between hematologic inflammatory markers and delirium. Controlled studies with larger sample sizes are needed to determine whether these markers have strong predictive value.

Measurement Properties of the Pediatric Anesthesia Emergence Delirium Scale: A Confirmatory Factor Analysis-Based Study.

Emergence delirium is a well-known and common problem in children recovering from anesthesia. The five-item Pediatric Anesthesia Emergence Delirium scale is one of the most commonly used instruments for assessing this condition, but the scale has been questioned regarding its latent structure, i.e., whether its items cover just one underlying construct. It has been suggested that the scale's first three items might identify emergence delirium better than the last two. The aim of this study was to evaluate the measurement properties of the Pediatric Anesthesia Emergence Delirium scale with a focus on its latent structure and cutoff scores, using appropriate statistical methods for ordinal data. A total of 350 children under 7 years of age, undergoing adenoidectomy, with or without additional tonsillotomy or minor procedures like paracentesis, tongue-tie release, or cerumen removal, were enrolled in the study. At the recovery unit, emergence delirium and pain were registered. The confirmatory factor analyses demonstrated that the two-factor model, including emergence delirium-specific behaviors (first three items) and emergence delirium-nonspecific behaviors (last two items), established an excellent model fit according to the χ2 goodness-of-fit statistics, Root Mean Square Error of Approximation, Comparative Fit Index, Tucker-Lewis Index, and Standardized Root Mean Square Residual. The ordinal alpha of 0.98 and the ordinal omega of 0.96 supported the internal consistency reliability of the emergence delirium-specific behaviors. The convergent validity was supported due to a strong correlation between emergence delirium-nonspecific behaviors and the Face, Legs, Activity, Cry, and Consolability scale. The receiver-operating characteristic curve analyses resulted in two tentative cutoff scores for emergence delirium-specific behaviors¸ ≥ 6 and ≥ 8. The Pediatric Anesthesia Emergence Delirium scale's first three items are a more valid and reliable measure of emergence delirium than its original five items.

Single centre implementation of the Paediatric Anaesthesia Emergence Delirium scale.

Early recognition of paediatric emergence delirium (ED) by post-anaesthesia care unit (PACU) nurses is critical for the effective management and prevention of complications. This project aimed to enhance nursing education and standardise the use of the Paediatric Anaesthesia Emergence Delirium (PAED) scale as a reliable tool for assessing ED. This project involved an educational intervention for PACU nurses to train them in using the PAED scale for ED evaluation. The effectiveness of the PAED scale was compared with the more commonly used Face, Legs, Activity, Cry, Consolability (FLACC) scale in the evaluation of postoperative paediatric patients. An educational programme was designed for PACU nurses, with pre-and post-surveys administered to assess the impact of the educational intervention on their knowledge, confidence, and familiarity with ED and the PAED scale. This project included time trials comparing the use of the PAED and FLACC scales during patient simulations after the educational intervention. Following the educational programe, nurses demonstrated increased confidence and familiarity with ED and the PAED scale. Furthermore, the use of the PAED scale following the educational intervention significantly reduced the time required to evaluate patients and initiate treatment for ED compared with the FLACC scale. Equipping nurses with the knowledge and skills to effectively implement the PAED scale improves ED's timely recognition and treatment, leading to safer, more efficient care for postoperative paediatric patients. This project demonstrates the importance of evidence-based tools and targeted nursing education.

Evaluation of Effect of Distraction Techniques Using Virtual Reality and Eight-dimension Audio Analgesia Methods on Pain Perception and Anxiety Levels in Children During Restorative Procedures: A Comparative In Vivo Study.

Dental pain and dental anxiety are the most common determinants of negative dental experience, the reason for broken appointments and ignored oral health care affecting the quality of life. To evaluate the effects of distraction techniques using virtual reality and eight-dimension (8D) audio analgesia method on pain perception and anxiety levels in children during restorative procedures. A total of 120 children between the ages of 4 and 10 years old who visited for the first time to a pediatric dental department were grouped equally between three interventional groups. Group I was treated with conventional tell-show-do (TSD) method; patients selected for group II (8D audio analgesia) and group III (virtual reality method) underwent two-step procedure that initially involved the TSD technique, by explaining the distraction techniques method conditioned for restoration treatment. Clinical evaluation of anxiety levels was measured by using the Chotta Bheem-Chutki (CBC), face, legs, activity, cry, consolability (FLACC) scale, and recording pulse and oxygen saturation rate. One-way analysis of variance (ANOVA) followed by post hoc Tukey's test was done to compare all the parameters between the three groups. In comparison to the conventional TSD method, both 8D audio analgesia and virtual reality method showed statistically better results. One-way ANOVA followed by post hoc Tukey's test showed no significant difference between the virtual reality group and 8D audio analgesic group. Both 8D audio analgesia and virtual reality box distraction techniques can be used as an efficient distraction technique for TSD during dental procedures in children. Karuppiah M, Balamurugan SR, Rajashekaran S, et al. Evaluation of Effect of Distraction Techniques Using Virtual Reality and Eight-dimension Audio Analgesia Methods on Pain Perception and Anxiety Levels in Children During Restorative Procedures: A Comparative In Vivo Study. Int J Clin Pediatr Dent 2024;17(10):1087-1092.

A randomized clinical trial of intranasal dexmedetomidine versus inhaled nitrous oxide for procedural sedation and analgesia in children

BackgroundProcedural sedation and analgesia is an important part of pediatric emergency care, safe and clinically useful alternatives for adequate management are necessary. The objective of this clinical trial was to evaluate the non-inferiority of intranasal dexmedetomidine to nitrous oxide with respect to analgesia for a painful procedure in children 3–15 years of age.MethodsThis prospective, equally randomized, open-label, non-inferiority trial was conducted at a Pediatric Emergency Department. Previously healthy children 3–15 years of age, with an extremity fracture or luxation or a burn and requiring procedural sedation and analgesia were eligible. Patients were randomized to receive either intranasal dexmedetomidine or inhaled nitrous oxide. The primary outcome measure was highest pain level during the procedure, assessed with Face, Legs, Activity, Cry, Consolability scale (FLACC). Mann-Whitney U test (continuous variables) and Fisher’s test (categorical variables) were used for statistical analysis.ResultsThe highest FLACC was median 4 (IQR 3–6) with intranasal dexmedetomidine and median 4 (IQR 2–6) with nitrous oxide. The median of the difference between samples from each group for FLACC was 0 with 95%CI (0–1), thus intranasal dexmedetomidine was not inferior to nitrous oxide with respect to the level of pain during the procedure. The same method for procedural sedation and analgesia would be accepted by 52/74 (82.5%) children and 65/74 (91.5%) parents in the intranasal dexmedetomidine group respectively 59/74 (88.1%) versus 70/74 (94.6%) with nitrous oxide. No serious adverse events were reported.ConclusionsThe results of this trial support that intranasal dexmedetomidine is not inferior to 50% nitrous oxide in providing analgesia for a painful procedure in children 3–15 years of age and can be considered as an alternative to 50% nitrous oxide for procedural sedation and analgesia.Trial registrationEudraCT 201,600,377,317, April 20, 2017. https://eudract.ema.europa.eu/.

Hemostatic effect of 3D-printed hip fixators in children with retinoblastoma after intra-arterial chemotherapy: a non-randomized controlled trial

This study aimed to investigate the benefits of using three-dimensional (3D)-printed hip joint fixators after intra-arterial chemotherapy (IAC) by inguinal femoral artery puncture in children with retinoblastoma. Overall, 79 cases of retinoblastoma who had undergone IAC through the femoral artery were selected and divided into an observation group of 50 cases and an intervention group of 29 cases according to the hemostasis method employed. The patients in the observation group were treated with sandbags for hemostasis, while those in the intervention group were given 3D-printed hip joint fixators to help immobilize the hips and sandbags. We used the Face, Legs, Activity, Cry and Consolability scale (FLACC), the Wong–Baker Facial Expression Pain Scale, and self-made questionnaires to evaluate demographics, clinical characteristics, pain, complications, satisfaction, and other indicators of the two groups. There were no significant differences in general data, such as age, gender, height, weight, manual compression time, diseased eye, tumor stage, platelet count, puncture times, pain distribution, and total score, between the groups. There was a positive correlation between FLACC pain and the total Wong–Baker pain score (r = 0.599, p < 0.001). During the 2 h of sandbag compression, sandbags were dislodged in the observation group as many as ten times, which was significantly higher than that in the intervention group (up to four times; p < 0.001). This was correlated with a very high score of satisfaction (92.34 ± 19.96 out of 100). The 3D-printed hip fixator is easy to operate, has a low incidence of complications, and saves time and effort. It effectively reduces the incidence of sandbags falling off after IAC in children with retinoblastoma and does not increase the patient’s pain. It is a method that could improve hemostasis in young children undergoing IAC by inguinal femoral artery.

Effect of Dexmedetomidine with or without Midazolam during procedural dental sedation in children: a randomized controlled clinical trial

BackgroundDental anxiety is a global problem in the realm of pediatric dentistry. The use of procedural sedation is recommended to avoid substandard or unsafe dental treatment in preschoolers. This study aimed to compare the effect sedation with Dexmedetomidine with or without Midazolam in terms of sedation level, analgesic effect and ease of treatment completion in preschool children.MethodsA triple blind randomized controlled clinical trial comprised 72 healthy uncooperative children, 4–6 years old, were randomly allocated into three groups of 24 patients each: Group I patients were sedated with nebulized 5 μg/kg Dexmedetomidine (DEX), Group II with nebulized 3 μg/kg DEX followed by nebulized 0.3 mg/kg Midazolam (MID), and Group III with nebulized 0.5 mg/kg MID. Along the session, the three regimens were assessed and compared during the sedation level (children responsiveness) using the Modified Observer’s Assessment of Alertness/Sedation Scale, the analgesic effect using the Face, Leg, Activity, Cry, Consolability scale and ease of treatment completion using a separate 5-point scale. Vital signs were recorded before and during sedation, until full recovery.ResultsA significant difference was detected regarding children responsiveness during operative procedure in favour of DEX in comparison to MID and DEX/MID groups (P = 0.045). Within the DEX group, a significant difference was recorded regarding children responsiveness at optimum sedation and during the operative procedure (P = 0.04). Although, the analgesic effects of sedative drugs showed no statistically significant difference among the study groups (P = 0.20), the ease of treatment completion was statistically higher in the DEX than MID and DEX/MID groups (P = 0.03).ConclusionDexmedetomidine provides a moderate level of sedation, that allowed better patient cooperation, and easy completion of performed dental procedures.

Assessment of Computer-Controlled Starpen Device and Conventional Aspirating Cartridge on Pain Perception in Paediatric Dental Patients – A Split-Mouth Crossover Study

Abstract Background: Local anaesthesia (LA) is the cornerstone for pain management of invasive dental procedures, but the process of delivering it may itself induce anxiety, especially in paediatric patients that can affect the pain perception. Advances such as the computer-controlled LA delivery system have expanded the horizons of LA and can serve as an alternative for painless injections. Objective: To examine the pain perception and anxiety reduction along with patient preference between computer-controlled Starpen device and conventional aspirating cartridge in LA administration for inferior alveolar nerve block. Materials and Methods: The patients were randomly allotted into two groups: Starpen and Septodont syringe where the LA injections were given using both the methods in the 1st week. After a washout period of 1 week, the crossover was performed and the other mode of LA administration was performed in the 2nd week. Pain scores were objectively recorded by the observer using the Face, Legs, Activity, Cry and Consolability (FLACC) scale during LA administration and extraction. Patients were asked to record the pain scores using the Visual Analogue Scale at three phases: (a) mucosa perforation, (b) needle insertion and (c) solution injection. The effect of pain perception on the vital parameters and the preference between the two techniques were assessed. Statistical Package for the Social Sciences (SPSS) version 23.0, Armonk, NY, USA: IBM Corp was used for statistical analysis, and Mann–Whitney U-test and unpaired t-test were utilised to compare the mean difference of two groups at significance level of 0.05. Results and Observations: Intergroup differences among the Starpen and Septodont syringe groups were found to be statistically significant (P &lt; 0.001) during both LA and extraction when pain was objectively assessed using FLACC. Conclusion: Computerised devices such as Starpen offer controlled release of local anaesthetics, effectively decreasing pain perception in paediatric patients and can form a mainstay for the behaviour management of young patients.

Comparative evaluation of three different behavior management techniques among children aged 6-12 years in dental practice: A single-center, double-blind, randomized controlled trial.

Dental anxiety is characterized by distress in anticipation of dental visits, which may result in a child's refusal to undergo treatment and, ultimately, lead to parents' reluctance towards dental care. The aim of this study was to evaluate and compare the effectiveness of the tell-show-do technique, modeling technique and yogic relaxation technique in the reduction of dental anxiety among children aged 6-12 years. The study was an interventional, parallel-group, single-center, double-blind, randomized controlled trial conducted on 120 children who required restorative treatment without the use of local anesthesia. The participants were selected based on specific inclusion and exclusion criteria and were randomly divided into 3 groups: group 1 - tell-show-do technique; group 2 - modeling technique; group 3 - yogic relaxation technique. The dental anxiety levels were evaluated 4 times using both physiological (oxygen saturation and pulse rate) and behavioral parameters (facial image scale (FIS) and the Face, Legs, Activity, Cry, and Consolability scale (FLACC)). The data was assessed by 2 blinded and calibrated specialists. Statistically significant differences were observed in all 4 parameters among the 3 groups. During both the intraoperative and postoperative periods, the oxygen saturation levels were significantly higher in the yogic relaxation technique group. Moreover, the yogic relaxation technique group exhibited lower pulse rates, FIS and FLACC scores compared to the tell-show-do and modeling technique groups. The practice of yoga has a positive influence on the general health of the individual. Consequently, it can be considered one of the alternative behavioral modification techniques for the reduction of dental anxiety in children.

The impact of oral melatonin on pain and anxiety reduction during venipuncture in pediatric patients: a double-blind randomized clinical trial

Background: Pain resulting from therapeutic procedures and injections is a prevalent source of stress for children. Immediate side effects of pain in infants include syncope, irritability, sleep disturbances, and nutritional issues. This study aimed to investigate the effects of oral melatonin on alleviating pain and anxiety in pediatric patients undergoing venipuncture. Methods: This double-blind, randomized controlled trial was conducted in the pediatric emergency ward. Patients were randomly assigned to one of two groups; the intervention group received 0.5 mg/kg of oral melatonin (maximum 5 mg) 30 min before venipuncture, while the placebo group received an equivalent amount of a placebo 30 min before the procedure. Using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, postcanulation fear, pain severity, compliance, and potential side effects were evaluated. Results: In total, 202 patients (113 male and 89 female) in the intervention and control groups were included in the analysis. The mean pain score during venipuncture was 1.52±3.04 in the intervention group and 2.04±6.57 in the control group (P&lt;0.001). In the intervention group, only 19 (18.8%) patients reported pain during venipuncture, whereas 79 (78.2%) patients in the control group reported pain (P&lt;0.001). Less than half (44.6%) of the patients in the intervention group experienced anxiety during venipuncture, while the majority (94.1%) of the patients in the control group exhibited anxiety (P&lt;0.001). The venipuncture success rate was 60.4% in the intervention group and 51.5% in the control group (P=0.257). Conclusion: Administering 0.5 mg/kg of oral Melatonin 30 min before venipuncture reduces procedure-related pain and anxiety in pediatric patients and may be associated with higher venipuncture success rates.

Effect of intravenous different drugs on the prevention of restlessness during recovery period of pediatric laparoscopic surgery: a randomized control trial.

To explored the impact of dexmedetomidine and esketamine in mitigating restlessness during the postoperative recovery phase following laparoscopic surgery in children. 102 individuals aged 1 to 7years experiencing laparoscopic surgery were randomly allocated into three groups, each accepting 1μg/kg of dexmedetomidine, 0.3mg/kg of esketamine, or saline immediately at the end of carbon dioxide pneumoperitoneum. Emergence agitation(EA) occurrence was assessed by PAED scale and 5-point agitation scale. Pain was judged using Face, Legs, Activity, Cry, and Consolability (FLACC) scale. The recovery time, extubation time, and post-anesthesia care unit (PACU) stay time were recorded for all three groups. Patients administered 1μg/kg of dexmedetomidine (8.8%) and individuals given 0.3mg/kg of esketamine (11.8%) showed lower incidences of emergence agitation compared to those receiving saline (35.5%; P = 0.009). There was no statistically significant difference in the time to discharge from the PACU among the three groups of patients (P > 0.05). The recovery time and extubation time were notably extended in the dexmedetomidine group (40.88 ± 12.95min, 42.50 ± 13.38min) when compared to the saline group (32.56 ± 13.05min, 33.29 ± 11.30min; P = 0.009, P = 0.010). Following CO2 pneumoperitoneum in pediatric laparoscopic surgeries, the intravenous administration of 1μg/kg dexmedetomidine or 0.3mg/kg esketamine effectively lowers EA occurrence without extending PACU time.

Ropivacaine combined with dexmedetomidine in ultrasound-guided axillary brachial plexus block in children, a randomized controlled trial

ObjectiveIn this study, we evaluated the efficacy and safety of 1 μg/kg dexmedetomidine as an adjuvant treatment to ropivacaine in children undergoing upper limb surgeries under ultrasound-guided axillary brachial plexus blocks and general anesthesia.MethodsWe enrolled 90 children (aged 1–8 years; ASA I-II) undergoing closed reduction and internal fixation for upper extremity fractures at the Xiamen Children's Hospital and randomly assigned them to one of two groups: L (injection with 0.25% ropivacaine) or D (injection with 0.25% ropivacaine containing 1 μg/kg dexmedetomidine) using the random number table method. The main outcome indicators recorded were the facial expression, leg activity, position, crying, and Face, Legs, Activity, Cry, and Consolability (FLACC) scale scores of children after surgery and the duration of block and analgesia maintenance. The secondary outcome indicators were vital sign data at the time of ultrasound probe placement (T1), at the time of block completion (T2), prior to the beginning of surgery (T3), 5 min after the beginning of surgery (T4), and at the end of surgery (T5), as well as the time of postoperative recovery, the number of cases of remedial analgesia, and complications.ResultsThere was no statistical difference between the two groups in terms of general data, block completion time, postoperative recovery time, and complications (P > 0.05). Compared to the L group, the D group had significantly lower FLACC scores at 6 h after surgery, as well as significantly lower systolic blood pressure, diastolic blood pressure, and heart rate values at T4 and T5, and significantly longer duration of postoperative analgesia maintenance (all P < 0.05).ConclusionDexmedetomidine (1 μg/kg) as a local anesthetic adjuvant to ropivacaine can alleviate pain at 6 h postoperatively, prolong analgesia maintenance, and reduce intraoperative blood pressure and heart rate in pediatric patients undergoing closed reduction and internal fixation for upper extremity fractures, with no obvious complications or delayed recovery.Clinical registry numberRegistration website: www.chictr.org.cn, Registration number: ChiCTR2200065163, Registration date: October, 30, 2022.

Immersive Virtual Reality Versus Video Distraction for the Management of Emergence Delirium in Children: A Randomized Controlled Study

PurposeEmergence delirium (ED) presents challenges for both parents and health care providers in pediatric surgical settings. This study aims to evaluate the effectiveness of immersive virtual reality (VR) distraction and video distraction combined with parental presence in reducing ED in preschool-aged children undergoing elective surgery. DesignA prospective, randomized, controlled clinical trial was conducted with 90 children ages 4 to 7. Participants were randomly assigned to three groups: VR distraction (group V), tablet video distraction with parental presence (group T), and standard care (group C). The primary endpoints were the incidence of ED and Pediatric Anesthesia Emergence Delirium Scale scores, with secondary measures encompassing scores from the Parental Separation Anxiety Scale and the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. MethodsParticipants were assigned to one of the three intervention groups, and relevant scales were used to assess ED, parental separation anxiety, and postoperative pain. The immersive VR distraction and video distraction with parental presence interventions were compared against standard care. FindingsImmersive VR distraction significantly reduced the incidence of ED (6.67% in group V vs 40% in group T and 60% in group C), and the incidence of ED in group V was notably lower than in the other groups (P = .023 vs group T and P = .004 vs group C). Children in group V displayed significantly lower FLACC compared with the other groups as well (P < .05). However, no significant differences between the 3 groups were observed in perioperative anxiety as assessed by the Parental Separation Anxiety Scale scores (P = .27). ConclusionsThis study underscores the potential of immersive VR distraction as an effective intervention for mitigating ED in pediatric surgical patients. The findings suggest that incorporating VR technology during the perioperative period can positively impact postoperative outcomes. Further research in diverse surgical contexts is recommended to validate these findings and explore the broader applicability of VR distraction in pediatric health care settings.

Postsurgical pain intensity in children on the VAS and FLACC scale across various analgesic techniques. Mathematical prediction as a component of justification

Nowadays, in pediatric practice, the Visual Analogue Scale (VAS) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale are effective for assessing postsurgical pain. The modern concept of pain management includes a multimodal approach, including regional analgesia techniques. The aim of the study was to present a mathematical model to assess the efficacy of regional analgesia techniques in managing postsurgical pain intensity on the VAS and FLACC scale up to the fifth day of the study and predict the behaviour of the experimental data function up to day 87 following surgery using the autoregressive probability model. Materials and Methods. 89 patients operated on the anterior abdominal wall were divided into 3 groups depending on the type of anesthesia. The assessment of pain management quality and the presence of acute pain was conducted using the VAS and FLACC scale on days 1, 2, 3, and 5 post-operatively in all children. The ‘predict’ function in РТС MathCad Prime 7.0. software was used to automate calculating predictions based on the Burg method. Results. Studying the efficiency of the proposed treatment using regional analgesia techniques versus conventional analgesia enabled the prediction of varying postsurgical pain intensities on the VAS and FLACC scale based on their mathematical models, with coefficient of determination R2=0.9876, R2= 0, 9827, R2=0.9952 for the FLACC scale and R2=0.9868, R2=0,915, R2=0.9774 for the VAS. Conclusions. The use of regional analgesia techniques in children undergoing anterior abdominal wall surgery has been confirmed to be associated with a significant reduction in postsurgical pain intensity to the fifth day of observation and predicted to remain so up to day 87

Effectiveness of Audiovisual Distraction in Reducing Children's Anxiety for Pain During Medical and Dental Treatments: A Systematic Review and Meta-analysis.

Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness. To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics. Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3-8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005-2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis. A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar. Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3-8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings. None. PROSPERO (Ref no.: CRD42021245874).

Peritonsillar Block with Triamcinolone as a Preemptive Analgesia in Tonsillectomy with Bipolar Electrocauter

Background: Tonsillectomy is one of the common types of ear, nose, and throat (ENT) surgery. Patients undergoing tonsillectomy frequently experience significant postoperative pain due to oropharyngeal muscle spasms and irritation of afferent nerve fibers. According to previous studies, triamcinolone for peritonsillar block was used to reduce postoperative pain in patients who have undergone tonsillectomy. The aims and objectives of this study were to observe the effectiveness of peritonsillar block using triamcinolone for reducing pain in patients with post-tonsillectomy using the bipolar electrocautery technique. Case: A 34-years-old male patient with chronic tonsillitis and obstructive sleep apnea (OSA) was undergoing tonsillectomy with general anesthesia and peritonsillar block after general anesthesia with triamcinolone 0,5 mg/kg body weight in the right and left fossa peritonsillar. Postoperative hemodynamic monitoring was carried out in the inpatient room. Patients were assessed for pain scale after tonsillectomy and side effects of triamcinolone, with pain indicator using the Wong-baker faces pain rating scale, numeric pain rating scale, and Face, legs, activity, cry and consolability (FLACC) Scale. Pain scales were assessed 1 hour after the tonsillectomy in the recovery room, 3 hours after the tonsillectomy in the inpatient room, 8 hours after the tonsillectomy in the inpatient room, 1 day after the tonsillectomy in the inpatient room, and 2 days after the tonsillectomy by phone. The patient went out of the hospital after 1 day of tonsillectomy. Conclusion: Peritonsillar block with triamcinolone is effective in reducing pain after tonsillectomy and can be the drug of choice when administering peritonsillar block.

Consolation Effect of Medical Clown Care Model in Children with Inguinal Hernia During Perioperative Period: A Single-Center Study in China

Background: Due to differences in medical backgrounds, there have been few studies on medical clown care in Chinese hospitals. Objectives: This study aimed to explore the consolatory effect of the medical clown care model on children in a Chinese hospital. Methods: This study included 236 children aged 4 - 6 years and divided them into an intervention group (n = 116) and a control group (n = 120). The control group received routine nursing measures, while the intervention group experienced the medical clown care model. To assess the children’s pain levels and the anxiety levels of their parents, the Face Legs Activity Cry and Consolability (FLACC) Scale, Wong-Baker FACES Pain Rating Scale (W-B FPS-R), and Self-Rating Anxiety Scale (SAS) were used. Results: The baseline data for both groups were comparable at admission (P &gt; 0.05). The FLACC score, W-B FPS-R score, and crying rate in the intervention group were significantly lower than those in the control group (4.81 vs 6.71, 4.69 vs 7.02, 44.83 % vs 79.16 %, P &lt; 0.05). Parents in the intervention group also had lower preoperative anxiety scores compared to those in the control group (42.85 vs 52.69, P &lt; 0.05). Furthermore, the postoperative pain incidence and drug use rates were significantly lower in the intervention group (18.97 % vs 30.83 %, 27.27 % vs 56.76 %, P &lt; 0.05). Compliance and satisfaction were significantly higher in the intervention group than in the control group (P &lt; 0.05). Conclusions: The application of the clown care model can effectively reduce children's pain, provide consolation, and relieve parental anxiety.