Faces Pain Scale Research Articles

Intranasal ketamine for peripheral venous access in pediatric patients: A randomized double blind and placebo controlled study

Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions.We performed a bicentric, prospective, observational cohort study. Patients aged 4–18 years were included if they received combined PSA with IN fentanyl and N2O for the reduction of mildly/moderately displaced fracture or of dislocation. Facial Pain Scale Revised (FPS-R) and Face, Leg, Activity, Cry, Consolability (FLACC) scores were used to evaluate pain and anxiety before, during and after procedure. University of Michigan Sedation Score (UMSS), adverse events, detailed side effects and satisfaction of patients, parents and medical staff were recorded at discharge. A follow up telephone call was made after 24–72 h.90 patients were included. There was no difference in FPS-R during the procedure (median score 2 versus 2), but the FLACC score was significantly higher as compared to before (median score 4 versus 0, Δ 2, 95% CI 0, 2). Median UMSS was 1 (95% CI 1, 2). We recorded no serious adverse events. Rate of vomiting was 12% (11/84). Satisfaction was high among participants responding to this question 85/88 (97%) of parents, 74/83 (89%) of patients and 82/85 (96%) of physicians would want the same sedation again.PSA with IN fentanyl and N2O is effective and safe for the reduction of mildly/moderately displaced fracture or dislocation, and has a high satisfaction rate.

Thermal camera as a pain monitor.

ObjectivesToday, many subjective methods are used to measure pain. Wong Baker and Hicks Facial Pain Scale is one of the most commonly used method. Clinicians grade pain according to the facial mimetic reaction of the patient. Unfortunately, there is no objective measure for monitoring pain. By using the same principle of the Wong Baker and Hicks Facial Pain Scale, in this study, we aimed to objectively measure pain by using a thermal camera to detect instant facial temperature changes.Materials and methodsThirty volunteers who attended blood collection unit were subjected to facial thermal monitoring and measurements were obtained 5 minutes before needle puncture (BNP), during needle puncture (DNP), and after needle puncture (ANP). Data were processed with TestoIRSoft 3.8 software program and mean temperatures of the whole face (FFM) and highest temperature points (HP), horizontal line (HOR) between two pupils and first glabellar wrinkle, and bilateral lines starting from the nasolabial sulcus to oral commissure (NLS-1 at right, NLS-2 at left) were evaluated. All data were statistically analyzed with paired sample t-test.ResultsStatistically, temperature measurements of HOR, NLS-1, NLS-2, HP, and FFM were significantly higher between BNP and DNP, significantly lower between ANP and DNP, and significantly higher between BNP and ANP (p<0.05). The most interesting result in our analysis was that the HP point was between the two eyebrows in 26 of the 30 volunteers.ConclusionOur results suggest that a thermal camera can be used to objectively monitor pain and in follow-up. However, further studies involving non-healthy volunteers (especially high-fever patients, children, immunosuppressive patients, and cancer and intensive care patients) should be performed.

Effects of alfentanil or fentanyl added to propofol for sedation in colonoscopy on cognitive functions: Randomized controlled trial.

To assess the effect of propofol supplemented with alfentanil or fentanyl on cognitive functions for sedation during elective colonoscopy. Patients (n=150, 18-65 years old, American Society of Anesthesiologists risk group I-III) scheduled undergo elective colonoscopy were included. They were randomized into three groups using the closed envelope methodpropofol-alfentanil (Group A), propofol-fentanyl (Group F), and propofol only (Group P).Group A patients were given an alfentanil (10 mcg/kg)-supplemented propofol bolus infusion and 5 mcg/kg alfentanil when necessary. Group F patients were given fentanyl (1 mcg/kg)-supplemented propofol and 0.5 mcg/kg fentanyl when necessary. Group P patients were given 1 mg/kg propofol and 0.5 mg/kg propofol when necessary. Vital signs, depth of sedation, recovery parameters, and patient and endoscopist satisfaction were recorded. Trieger dot test (TDT) and Digit Symbol Substitution Test (DSST) were performed post procedure. Demographic data were similar among all patients in the groups. Bispectral index values were lower in Group P (p<0.001). DSST scores were higher in Group A (p=0.004). TDT scores and Facial Pain Scale scores were higher in Group P (p<0.005). Apnea incidence (p=0.009) and Observer's Assessment of Alertness/Sedation Scale scores (p=0.002) were also higher in Group P. Patient satisfaction and endoscopist satisfaction were similar among all patients. Compared with propofol-alfentanil and propofol-fentanyl, propofol alone is associated with an increased incidence of apnea, drug consumption, and reported pain. Propofol-alfentanil has a less negative effect on cognitive functions than propofol alone or propofol-fentanyl.

A Randomized Double-Blind Trial Comparing the Effect on Pain of an Oral Sucrose Solution vs. Placebo in Children 1 to 3 Months Old Undergoing Simple Venipuncture

BackgroundFew clinical trials evaluating the efficacy of oral sweet solutions for procedures in the emergency department (ED) have been published. ObjectivesTo compare the efficacy of an oral sucrose solution vs. a placebo in reducing pain in infants undergoing venipuncture without cannulation. MethodsA randomized, double-blinded clinical trial was conducted in a pediatric ED. Infants 1 to 3 months old were randomly allocated to receive 2 mL of 88% sucrose or 2 mL of placebo, 2 min prior to venipuncture. The outcome measures were the difference in pain levels as assessed by the Face, Legs, Activity, Cry and Consolability Pain Scale (FLACC) and Neonatal Infant Pain Scale (NIPS) scores, crying time, and variations in heart rate. ResultsEighty-two participants were recruited. Data were analyzed for 38 patients from each group (excluding protocol deviations). The mean difference in FLACC scores 1 min post venipuncture compared with baseline was 2.84 ± .64 (sucrose) vs. 2.71 ± .62 (placebo) (p = 0.98). For the NIPS score, it was 2.32 ± .47 (sucrose) vs. 1.63 ± .49 (placebo) (p = 0.60). The difference in the median crying time was not statistically significant between the two groups: 63.0 ± 3 (sucrose) vs. 48.5 ± 5 s (placebo) (p = 0.17). No significant difference was found in participants' heart rates 1 min post venipuncture compared with baseline: 33 ± 6 (sucrose) vs. 24 ± 5 beats per minute (placebo) (p = 0.44). ConclusionsIn infants 1 to 3 months of age undergoing simple venipuncture, administration of an oral sweet solution did not statistically decrease pain scores, and participants' heart rate variations and crying time were not significantly changed.

Correlation between MRI and hip arthroscopy in children with Legg-Calve-Perthes disease.

Most of the information available about Legg-Calve-Perthes disease (LCPD) at present is gained through imaging modalities including plain radiographs and magnetic resonance imaging (MRI). But the accuracy of MRI in this disease and its predictive value to reveal various intra-articular pathologies is not known. We correlated the findings of MRI with those seen on hip arthroscopy in children with active stage of LCPD. We conducted a prospective observational study in which MRI findings were correlated with corresponding findings on hip arthroscopy in a cohort of 25 patients of active LCPD below 12years of age. The parameters noted on MRI included status of ligamentum teres, status of the labrum, synovial effusion if any, condition of the femoral and acetabular articular cartilage including chondral flaps, chondral indentation and intra-articular loose bodies. The indication of performing hip arthroscopy was persistent severe hip pain (Wong-Baker FACES pain scale ≥3) after 6months of conservative management. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRI considering arthroscopy as a gold standard. Synovial effusion was seen in a large number of patients on both MRI (17) and hip arthroscopy (24). The sensitivity (95% confidence interval) of MRI was found to be low, especially with respect to labral tears [25% (0.63-80.6)] and intra-articular loose bodies [20% (0.51-71.6)]. NPV for synovial effusion was also found to be low [12.5% (0.32-52.7)], although specificity and PPV of MRI were found to be good for all the parameters. MRI cannot be completely relied upon for identifying all the intra-articular pathologies in children with LCPD, although it has a good complimentary role. In patients with severe persistent pain with suspicion for joint changes, hip arthroscopy can provide a safe and efficient procedure (better than MRI) for eliciting the associated joint pathology.

Effect of Face-to-Face Education on Anxiety and Pain in Children with Minor Extremity Injuries Undergoing Outpatient Suturing in Emergency Department

ObjectiveTo assess the effect of face-to-face education on anxiety and pain in children with minor extremity injuries undergoing outpatient suturing.MethodsChildren in intervention and control groups received face-to-face education (10 minutes) and no specific education, respectively. The anxiety and pain was measured using Modified-Yale Preoperative Anxiety Scale, and pain by Faces Pain Scale–Revised, respectively in 3 stages viz, pre-procedure and pre-intervention, post-procedure.ResultsChildren in the intervention group were less anxious than the control at pre-procedure and post-intervention stage (41.1 (13.8) vs. 46.3 (19.1), respectively, P=0.03) and post-procedure and post-intervention stage (32.3 (17.2) vs. 40.2 (12.9), respectively, P=0.01). Children in the intervention group experienced less pain than the control at pre-procedure and post-intervention stage (3.9 (3.8) vs. 4.9 (3.1), respectively, P<0.001) and post-procedure and post-intervention stage (3.1 (1.2) vs. 4.0 (2.1), respectively, P=0.001).ConclusionsFace-to-face education could reduce anxiety and pain in children undergoing suturing in the emergency department.

Protocol for a randomised control trial of bisphosphonate (zoledronic acid) treatment in childhood femoral head avascular necrosis due to Perthes disease

IntroductionPerthes disease (PD) is an idiopathic disorder presenting with avascular necrosis to the femoral head, which frequently results in flattening. Long-term function is directly related to the subsequent femoral head...

The Application of One-Hour Static Qigong Program to Decrease Needle Pain of Korean Adolescents With Type 1 Diabetes: A Randomized Crossover Design.

The aim of this study was to describe application of a static Qigong program to decrease needle pain in Korean adolescents with type 1 diabetes and its pilot test results. The pilot study was a randomized crossover design including 26 adolescents randomized to Qigong or rest group. Participants received a 60-minute Qigong program consisted of warm up, deep breathing, imaginary, and a closing warm up. After 24-hour washout period, treatment assignments were switched. We collected before and after intervention using a self-administered questionnaire, which included the faces pain scale to assess expected and perceived pain during blood sugar testing and insulin injection and the Positive and Negative Affect Schedule. Only expected pain on insulin injection was significantly lower after intervention (P = .025). The results suggested that the devised static Qigong program was feasible intervention to decrease at least expected pain on insulin injection of adolescents with type 1 diabetes.

Point-of-Care US and Nonangulated Forearm Fractures

Research Article| August 01 2017 Point-of-Care US and Nonangulated Forearm Fractures AAP Grand Rounds (2017) 38 (2): 17. https://doi.org/10.1542/gr.38-2-17 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Point-of-Care US and Nonangulated Forearm Fractures. AAP Grand Rounds August 2017; 38 (2): 17. https://doi.org/10.1542/gr.38-2-17 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: diagnostic radiologic examination, forearm fractures, point-of-care ultrasonography, pain Source: Poonai N, Myslik F, Joubert G, et al. Point-of-care ultrasound for nonangulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med. 2017; 24(5): 607– 616; doi: https://doi.org/10.1111/acem.13146Google Scholar Researchers from multiple Canadian institutions conducted a cross-sectional study to determine the utility of point-of-care ultrasonography (POCUS) in children with suspected nonangulated distal forearm fractures. Children were eligible if they were 4–17 years old and presented to the study emergency department (ED) with a suspected nonangulated distal forearm fracture, defined as maximal pain and tenderness at the distal third of the forearm after an acute fall on an outstretched hand. Each participant underwent radiography and POCUS of the distal ulna and radius. POCUS was performed and interpreted by 4 POCUS-certified pediatric ED physicians with at least 2 years of POCUS experience who were not involved in the patient’s care. POCUS evaluators were blinded to the radiographs, and radiography technicians and radiologists were blinded to POCUS interpretations. Each study child was classified as having a fracture or not on the basis of a radiologist’s interpretation of the patient’s radiographs. The primary outcome was the sensitivity and specificity of the POCUS evaluation by the ED physician (fracture or no fracture) when compared to radiograph interpretation. Secondary outcomes included (a) patient self-reported pain immediately after radiography and POCUS by using Faces Pain Scale–Revised scores, (b) caregiver satisfaction with each imaging procedure by using a single-item question and a 5-point Likert scale, and (c) duration of POCUS and radiography procedures. Of 169 children enrolled, 76 had a fracture on radiographs. The most common type was a buckle fracture (80%). The sensitivity and specificity of POCUS were 94.7% (95% confidence interval [CI], 89.7%–99.8%) and 93.5% (95% CI, 88.6%–98.5%), respectively. There were 4 fractures missed with POCUS (1 distal radius buckle fracture and 3 ulnar styloid factures). There were 6 nonfractures that were interpreted as fractures at POCUS. POCUS was associated with a significantly lower median pain score when compared with radiography. There was no significant difference in median caregiver satisfaction scores with POCUS and radiographic procedures. POCUS was associated with a significantly lower median procedure duration than radiography (1.5 vs 27 minutes, respectively; P < .001). The researchers conclude that using POCUS to assess distal forearm injuries in children is accurate, timely, and associated with low levels of pain. Dr Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. POCUS is a useful tool in the pediatric ED setting. The current study is 1 of several published in recent years to evaluate its use in forearm fractures in children. A recent meta-analysis of these studies supports the high sensitivity and specificity reported in the present study,1 which excluded children with obvious forearm deformities and thereby reduced the potential for inflated test performance. Few prior studies have been conducted to evaluate pain... You do not currently have access to this content.

Effect of age factor on analgesic efficacy of morphine during recovery from remifentanil-based anesthesia in pediatric patients undergoing minor surgery

Objective To evaluate the effect of age factor on the analgesic efficacy of morphine during recovery from remifentanil-based anesthesia in pediatric patients undergoing minor surgery. Methods Fifty pediatric patients of both sexes, aged 3-10 yr, with body mass index ≤30 kg/m2, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, scheduled for elective tonsillectomy, were divided into preschool group (3-5 yr, n=30) and school-age group (6-10 yr, n=20) according to age.Anesthesia was induced by inhaling 8% sevoflurane and IV morphine 0.1 mg/kg.Pediatric patients were mechanically ventilated after tracheal intubation, and end-tidal pressure of carbon dioxide was maintained between 35-45 mmHg.Anesthesia was maintained by inhalation of 2%-3% sevoflurane and IV infusion of remifentanil 0.2 μg·kg-1·min-1.Pain was evaluated using Faces Pain Scale (FPS) and Face Legs Activity Cry Consolability (FLACC) scale during the recovery period in the postanesthesia care unit.When FPS or FLACC scores ≥4, morphine 0.05 mg/kg was intravenously injected.When pain was still unrelieved after morphine was given for 2 times (time interval 5 min), fentanyl 1 μg/kg was intravenously injected until FPS and FLACC scores <4.The requirement for analgesics and consumption of analgesics (fentanyl consumption was converted into morphine consumption) were recorded.The development of nausea and vomiting, pruritus and respiratory depression was also recorded. Results Compared with preschool group, the requirement for analgesics and consumption of analgesics were significantly decreased during recovery from anesthesia (P 0.05). No pruritus or respiratory depression was found in two groups. Conclusion The analgesic efficacy of morphine is affected by age factors during recovery from remifentanil-based anesthesia in pediatric patients undergoing minor surgery, and morphine produces better analgesic efficacy in school-age pediatric patients than in preschool pediatric patients. Key words: Age factors; Morphine; Piperidines; Child; Analgesia

A randomized controlled clinical trial evaluating quality of life when using a simple acupressure protocol in women with primary dysmenorrhea

ObjectiveTo evaluate a simple acupressure protocol in LIV3 and LI4 acupoints in women with primary dysmenorrhea. MethodsThis paper reports a randomized, single blinded clinical trial. 90 young women with dysmenorrhea were recruited to three groups to receive 20min acupressure every day in either LIV3 or LI4, or placebo points. Acupressure was timed five days before menstruation for three successive menstrual cycles. On menstruation, each participant completed the Wong Baker faces pain scale, and the quality of life short form −12 (QOL SF-12). ResultsIntensity and duration of pain between the three groups in the second and third cycles during the intervention (p<0.05) differed significantly. Significant differences were seen in all domains of QOL except for mental health (p=0.4), general health (p=0.7) and mental subscale component (p=0.12) in the second cycle, and mental health (p=0.9), and mental subscale component (p=0.14) in the third cycle. ConclusionPerforming the simple acupressure protocol is an effective method to decrease the intensity and duration of dysmenorrhea, and improve the QOL.Registration ID in IRCT: IRCT2016052428038N1

Acceptance and efficiency of anesthesia by photobiomodulation therapy during conventional cavity preparation in permanent teeth: a pilot randomized crossover clinical study

Fear and anxiety for pain makes people avoid dental treatments. The main aim of the study was to evaluate the acceptance and efficiency of pulpal anesthesia induced by photobiomodulation (PBM) therapy, during conventional cavity preparation of decayed permanent teeth. Patients of 11–25 years old (n = 24) were included in a split-mouth and randomized crossover clinical study. Conventional cavity treatment was made in two contralateral decayed teeth of the same arch, in similar extent of caries ICDAS 4 or 5, of each patient, one under conventional local anesthesia by pharmacological agents (control group) and another under pulpal anesthesia induced by PBM therapy (PBM group). The diode laser irradiation parameters were 810 nm wavelength, CW, non-contact mode, 600 μm hand piece, 6 mm, 250 mW, 120 s (60 s buccal, 60 s lingual), 0.88 W/cm2, 106.2 J/cm2, 30 J. The Wong Baker’s faces pain scale was used for assessing the discomfort levels, whereas the acceptance was obtained by asking the preference of the patient. Data were statistically compared using the Mann-Whitney Wilcoxon’s test (p < 0.05). For laser anesthesia (PBM group), the mean discomfort valued was 1.37 ± 1.55, similar to that for injection anesthesia (control group) which was 1.25 ± 1.53 (p = 0.59), independently of the ICDAS classification. Twenty-two out of 24 patients replied that they prefer the method with the laser (91.7%). This pilot study demonstrated the clinical effectiveness and acceptance of PBM induces pulpal anesthesia for cavity preparation of decayed permanent teeth and deserves further research and development.

Clinical manifestation of pediatric acute pancreatitis - a prospective multicenter nationwide cohort

The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain.Ninety-two children (5–15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE). Measures: Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac.These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated.SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.

A comparative study to evaluate the efficacy of platelet-rich plasma and triamcinolone to treat tennis elbow.

Background:Lateral elbow pain is common with a population prevalence of 1%–3%. The study was a comparative trial to validate the efficacy of single injection of platelet-rich plasma (PRP) for tennis elbow as compared with single injections of triamcinolone and placebo (normal saline) over a short term period.Materials and Methods:Comparative trial with 3- and 6-month followup evaluated with visual analog scale (VAS) and facial pain scale (FPS). Our study included a total of eighty patients with unilateral or bilateral tennis elbows. The study population included patients between 20 and 40 years age group belonging to either sex with seventy unilateral and ten bilateral affections for more than 3-month duration. Patients suffering from elbow pain due to other problems or those who have received any form of injection were excluded from the study. One milliliter of 2% Xylocaine injection was given before injecting the proposed formulation under trial. VAS and FPS were used for scoring pain. Kruskal–Wallis test and Mann–Whitney U-tests were used for statistical analyses at 12 and 24 weeks.Results:Overall, 49 females and 31 males were included with thirty elbows in each group. Both the PRP and triamcinolone groups had better pain relief at 3 and 6 months as compared to normal saline group (P < 0.05), but at 6 months followup, the PRP group had statistically significant better pain relief than triamcinolone group. In the triamcinolone group, 13 patients had injection site hypopigmentation and 3 patients had subdermal atrophy.Conclusion:Over a short term period, PRP gives better pain relief than triamcinolone or normal saline in tennis elbow which needs to be validated over long term period by further studies.

INFLUENCE OF CANCER SEVERITY AND FUNCTIONAL STATUS OF CANCER ON CARDIAC PARASYMPATHETIC INDICATORS

Objective: To investigate the influence of cancer severity and functional status of cancer patients on cardiac parasympathetic indicators. Methods: A total of 267 patients with a fresh clinical diagnosis of solid malignant tumor not yet put on cancer therapy and 250 controls matched for age, sex of study subjects were included. Severity of cancer was defined based on the American Joint Committee on Cancer staging. Accordingly, study subjects were subdivided into early stage (Stage I and II combined) and advanced stage (Stage III and IV combined). In cancer patients, the Eastern Cooperative Oncology Group (ECOG) performance score and the Faces Pain Scale score (FPS) was noted. Two indicators of vagal function, expiratory:inspiratory ratio (E:I ratio) and root mean square of successive N-N interval difference (r-MSSD) were included. E:I ratio during deep breathing at six respiratory cycles/minute and r-MSSD at rest was obtained from 1 minute lead II electrocardiogram. Data were analyzed by applying suitable statistical tests. p≤0.05 was considered significant. Results: R-MSSD and E:I ratio was significantly reduced in the early and advanced stage of cancer compared to controls (p≤0.0001). r-MSSD and E:I ratio was significantly reduced in advanced stage compared to the early stage of cancer (p≤0.0001). r-MSSD and E:I ratio was significantly different in subgroups of stages of cancer and controls (p≤0.0001). In cancer patients, r-MSSD was negatively correlated with ECOG and FPS score (p≤0.0278, p≤0.0100). Conclusion: Severity of cancer affects vagal function. However, r-MSSD alone was associated with functional status (ECOG, FPS) of cancer patients.

ORAL MORPHINE VERSUS IBUPROFEN FOR AT-HOME POST-OPERATIVE ORTHOPAEDIC PAIN IN CHILDREN: A RANDOMIZED CONTROLLED TRIAL

BACKGROUND: Most paediatric surgical procedures are currently performed on an outpatient basis and pain is the most common complaint of children. Oral morphine is being increasingly prescribed. However, evidence supporting its use for at home therapy post-operatively is non-existent. Given the growing fears surrounding opioids, an evaluation of oral morphine’s effectiveness was urgently needed in this clinical context. OBJECTIVES: We sought to evaluate whether oral morphine was superior to ibuprofen for children’s pain at home, following ambulatory orthopaedic surgery. DESIGN/METHODS: We conducted a parallel-group, randomized, blinded superiority trial comparing oral morphine (0.5 mg/kg, maximum 200 mg) to ibuprofen (10 mg/kg, maximum 600 mg) for at home therapy in children 5-17 years who underwent outpatient orthopaedic surgery. Participants were asked to take the intervention at home every 6 hours as needed for pain for 48 hours. The primary outcome was the pre-post difference in pain scores using the Faces Pain Scale – Revised (FPS-R) for the first medication dose. Secondary outcomes included the pre-post difference in pain scores using the FPS-R for the second to eighth doses, breakthrough acetaminophen doses for pain, unscheduled visits to a health care provider within 96 hours, and the type and frequency of adverse effects. RESULTS: We analyzed the results of 65 participants in the morphine group and 67 in the ibuprofen group. At each dose, both morphine and ibuprofen decreased pain scores with no difference in efficacy. Respectively, the mean (SD) pre-post difference was 1.1 (1), 1.8 (1.1), delta (∆) 0.3, 95% CI: -0.1, 0.7) (first); 1 (1.1), 1 (1), ∆: 0, 95% CI: -0.4, 0.4 (second); 1 (1.1), 0.9 (1.1), ∆: 0.1, 95% CI: -0.3, 0.5 (third); 0.9 (0.9), 0.9 (1), ∆: 0, 95% CI: -0.4, 0.4 (fourth); 0.8 (0.9), 0.9 (1.1), ∆: -0.2, 95% CI: -0.6, 0.2 (fifth); 0.8 (1), 0.7 (1), ∆: 0.1, 95% CI: -0.4, 0.5 (sixth); 0.6 (0.9), 0.6 (0.8), ∆: 0.1, 95% CI: -0.3, 0.4 (seventh); 0.4 (0.7), 0.5 (0.7), ∆: -0.1, 95% CI: -0.5, 0.2 (eighth). Significantly more participants in the morphine group (45/65, 69% versus 26/67, 39%) experienced adverse effects, most commonly drowsiness. There were no differences in health care visits. CONCLUSION: Both oral morphine and ibuprofen decreased pain at home with no difference in analgesic efficacy. Oral morphine was associated with significantly more adverse effects, suggesting ibuprofen is an effective and safer option for at home management of mild to moderate pain following ambulatory orthopaedic surgery.

GD03: Hyoscine butylbromide (Buscopan) versus acetaminophen for non-surgical abdominal pain in children: a randomized controlled superiority trial

Background: Children with abdominal pain in the emergency department (ED) are at particular risk of suboptimal analgesia due to fears of missing appendicitis and absent guidelines. Many still experience pain at discharge. Acetaminophen is the most commonly used analgesic and efficacy of hyoscine butylbromide (HBB) is supported by adult evidence. However, no evidence exists for either agent in children with abdominal pain. Objective: To determine if HBB is superior to acetaminophen for abdominal pain in children. Methods: We will consecutively recruit children 8-17 years presenting to the ED with presumed non-surgical abdominal pain rated &amp;gt;4/10 on the Faces Pain Scale – Revised (FPS-R) and described as colicky, excluding:-Suspected appendicitis or bowel obstruction-Anticholinergic, analgesic, or antispasmodic &amp;lt;12 hours-Peritoneal inflammation-Unable to swallow pills-Hypersensitivity to either intervention-Medically unstable-Previous bowel obstruction, abdominal surgery, myasthenia gravis, liver disease, glaucoma, or recent abdominal trauma (&amp;lt;48 hours)-Toxin ingestion (&amp;lt;24 hours)-Vomiting-Pregnancy Randomization and allocation concealment will be pharmacy-controlled and performed using a computerized random number generator and sequentially numbered, opaque, sealed envelopes, respectively. The physician, research assistant, nurse, and participant will be blinded. Due to perceptible differences, participants will be randomized in a double-dummy approach to:-HBB 10 mg tablet + acetaminophen placebo OR-Acetaminophen 15 mg/kg liquid (maximum 975 mg) + HBB placebo. The primary outcome will be the difference from baseline on the FPS-R at 120 minutes, reflecting HBB’s time to peak plasma concentration. The FPS-R has been validated in children &amp;gt;five years. Secondary outcomes include:-Pain scores at 15, 30, 45, 60, 80, 100, and 120 minutes post-intervention (FPS-R and 100 mm visual analog scale)-Discharge pain score-Rescue analgesia-Time to achieve a 20% reduction in pain-Adverse effects-Recidivism &amp;lt;48 hours-Missed surgical diagnoses (National Ambulatory Care Reporting System (NACRS) database)-Caregiver satisfaction (five-item Likert scale). Using the intention to treat principle, ordinal, ratio, and categorical data will be analyzed using the Mann-Whitney, paired t-test, and Pearson’s chi-square, respectively and summarized using 95% confidence intervals. Assuming a standard deviation of 2 faces, 83 children per group will be required to detect a 1-face difference at 5% significance with 90% power. Increasing by 20% equals 100 participants per group. P values &amp;lt;0.05 will be considered significant. An institutional audit revealed 380 eligible patients per year during research assistant availability. Given a 30% refusal rate, we expect five participants enrolled per week for 40 weeks. Importance: Our findings will guide evidence-based analgesic choices for children with non-surgical abdominal pain in the ED.

MP24: Effect on pain of an oral sucrose solution versus placebo in children 1 to 3 months old needing nasopharyngeal aspiration; a randomized controlled trial

Introduction: Oral sweet solutions have been accepted as effective pain reducing agents for neonates. However studies in the Emergency Department (ED) setting have conflicting results. The objective is to compare the efficacy of an oral sucrose solution versus placebo in reducing pain in children 1 to 3 months of age during nasopharyngeal aspiration (NPA) in the ED. Methods: A randomized, double-blinded, placebo controlled clinical trial was conducted in a pediatric university-affiliated hospital ED. Participants from 1 to 3 months of age requiring NPA were recruited and randomly allocated to receive 2 mls of an 88% sucrose solution (SUC) or 2 mls of a placebo solution (PLA) orally, 2 mins before NPA. The primary outcome was the mean difference in pain scores at 1 min post NPA as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale. Secondary outcomes were the difference in pain scores using the Neonatal Infant Pain Scale (NIPS), crying time, heart rate and adverse events. Results: 72 participants were recruited and completed the study, 37 (group SUC) and 35 (group PLA) respectively. Both groups had similar demographic and clinical characteristics and baseline FLACC and NIPS pain scores (all p=value &amp;gt;0.4). The mean difference in FLACC scores compared to baseline was 3.3 (2.5-4.1) (SUC) vs. 3.2 (2.3-4.1) (PLA) (p=.94) at 1 min and -1.2 (-1.7 to 0.7) (SUC) vs. -0.8 (-1.5 to -0.1) (PLA) (p=.66) at 3 mins after NPA. For the NIPS scores, it was 2.3 (1.6-3.0) (SUC) vs. 2.5 (1.8-3.2) (PLA) (p=.86) at 1 min and -1.2 (-1.6 to -0.8) (SUC) vs. -0.8 (-1.3 to 0.2) (PLA) (p=.59) 3 mins after NPA. There was no difference in the mean crying time, 114 (98-130) secs (SUC) vs. 109 (92-126) secs (PLA) (p=.81). No significant difference was found in participants’ heart rate at 1 min 174 (154-194) BPM (SUC) vs. 179 (160-198) BPM (PLA) (p=.32) and at 3 mins 165 (143-187) BPM (SUC) vs. 164 (142-186) BPM (PLA) (p=.86) after NPA. Three patients had vomiting during the procedure (2 PLA and 1 SUC), and one had an episode of chocking (PLA). Conclusion: In infants 1 to 3 months of age undergoing nasopharyngeal aspiration in the ED, administration of an oral sweet solution did not statistically decrease pain scores as measured by the FLACC and NIPS scales. Participants’ heart rate and crying time were not significantly decreased when sucrose was provided.

Randomized controlled trial of intravenous acetaminophen for postcesarean delivery pain control

Cesarean delivery is a common surgery in the United States, with 1.3 million performed during 2009.1 Obstetricians must balance the growing concern with opioid abuse, dependence, and side effects with optimal postoperative pain control. Intravenous acetaminophen may represent an additional method to decrease the reliance on opioid medications and improve postoperative pain following cesarean delivery. The objective of the study was to determine whether the administration of intravenous acetaminophen following routine scheduled cesarean delivery would decrease the need for narcotic medications to control postoperative pain. This was an institutional review board-approved, double-blind, placebo-controlled, randomized trial, registered on clinicaltrials.gov (number 02046382). Women scheduled to undergo cesarean delivery with regional anesthesia at term were recruited. All perioperative and postpartum care was standardized via study order sets. Study patients were given all medications in a standardized manner receiving either acetaminophen 1000 mg intravenously or 100 mL saline (placebo) every 8 hours for 48 hours for a total of 6 doses. The pharmacy prepared intravenous acetaminophen and saline in identical administration bags labeled study drug to ensure blinding. The initial dose of study drug was given within 60 minutes of skin incision. Quantity of breakthrough and scheduled analgesic medications and self-reported pain levels on the Faces Pain Scale (0-10) before and after study drug administration were collected. Patient demographics were extracted from the chart. Power calculation determined that 45 patientsper arm were required to detect a 30% reduction in postcesarean narcotic requirement with 80% power and a significance level of P= .05. A total of 133 patients were consented for the study. Twenty-nine were excluded and 104 patients completed the study: 57 received intravenous acetaminophen and 47 received placebo. There were no differences in baseline demographic characteristics including patient age, body mass index, gravidity, parity, race, comorbidities, or number of prior cesarean deliveries. There were no differences between groups in estimated blood loss or length of stay. The total amount of oral narcotic medications consumed by patients receiving intravenous acetaminophen was significantly reduced when compared with the placebo group (47 mg vs 65 mg of oxycodone; P= .034). The total amount of ibuprofen used between groups was not different. There was no difference in pain scores between groups before and after study dose administration. There was no significant difference in narcotic side effects (nausea/emesis, respiratory depression, constipation) in either study arm. Intravenous acetaminophen in the postoperative period following cesarean delivery resulted in a significant decrease in oral narcotic consumption for pain control.

Optimization of postoperative analgesia after adenoidectomy in children

It is known that pharyngalgia is very common after tonsillectomy. It should be emphasized that the intensity of pain after adenoidectomy in children is not less important than after adenotonsillectomy. Despite the availability of standardized pain assessment scales and existing postoperative analgesia recommendations, unresolved postoperative pain still occurs in children. The research included 117 children with an average age of 7.5 ± 0.4 years, who underwent adenoidectomy at the Department of Anesthesiology and Intensive Care of "Regional Children’s Clinical Hospital" of Kharkov city in 2014. Depending on the method of general anesthesia, patients were divided into 3 groups: group I (n = 41) those who received propofol in combination with fentanyl; group II (n = 40) those who received sevoflurane in combination with fentanyl; group III (n = 36) those who received thiopental sodium combined with fentanyl. We monitored the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, BIS-index, heart rate variability, respiration rate, and SpO2. We determined the levels of cortisol and insulin in the blood serum, glucose level, the ratio of cortisol/insulin was calculated. Assessment of the efficiency of postoperative analgesia was performed using the Wong-Baker FACES Pain Scale («Faces») and the Oucher Scale. The result of analysis of the intensity of postoperative pain determined that at the 1st hour after the operation by the «Faces» and Oucher scales, it was significantly higher in patients of group II compared with the patients of group I and group III. The morning after the operation there was no significant difference in the pain scales, and the number of scale points showed that children from all groups did not have pain. According to the data of ANOVA it was determined that only the patients in group I with indicator ΔBIS-index «intubation – traumatic moment of operation» experienced postoperative pain intensity on the «Faces» scale. A very strong correlation between «cortisol – BIS index» was observed during the traumatic moment of operation and unidirectional positive correlations were seen both between ΔBIS-index «intubation-the traumatic moment of operation» and between the level of cortisolemia (Δcortisol before surgery – the traumatic moment of operation, Δcortisol extubation – the 1st day after the surgery and Δcortisol before surgery – the 1st day after the surgery) and the intensity of postoperative pain by the «Faces» and Oucher scales. The around-the-clock prescribed administration of ibuprofen at dose 10 mg/kg after adenoidectomy provided effective postoperative analgesia. At the 1st hour after the operation lower pain intensity was revealed in patients using propofol in combination with fentanyl by both pain scales. We believe that propofol is able to influence the level of cortisol and assume that due to minimal changes in the level of cortisol during the perioperative period, propofol can reduce the intensity of postoperative pain.