Faces Pain Scale Research Articles

The Effect of Hypnoanesthesia on Serotonin

Background: Every minor and major surgical procedure requires anesthesia to relieve pain during surgery. The neuro-biomolecular mechanism of pain relief in hypnoanesthesia remains uncomprehended. Objective: This study aims to observe the effect of hypnoanesthesia on several neurotransmitters, including serotonin, glutamic acid, and substance P, which play a role in the mechanism of pain. Methods: The study subjects included patients with benign soft tissue tumors consisting of 40 people who were divided into two groups, namely treatment and control groups. Minor surgery with hypnoanesthesia was performed in the treatment group, whereas in the control group, minor surgery was performed with 2% lidocaine local anesthetic. Pain in both groups was measured by FPS (Face Pain Scale) and monitored by a vital sign monitor. The processes of the study were recorded with a camcorder. Changes in serum levels of excitatory (glutamic acid and substance P) and inhibitory (serotonin) neurotransmitters before and after the intervention were analyzed using ELISA (Enzym-Link Immunosorbent Assay) in both groups. Results: The control and treatment groups had the same end result, which was pain relief. The results of regression and ANOVA analysis indicated that serotonin simultaneously had a significant effect on substance P at 98.4% and glutamic acid at 98.2%. Conclusion: There was no statistically significant change in serotonin levels before and after hypnoanesthesia. Serotonin, as an inhibitory neurotransmitter, simultaneously has a significant effect on both excitatory neurotransmitters, namely Glutamate Acid and Substance P, in the mechanism of nociceptive pain relief with hypnosis.

Effect of Hypnoanesthesia on Endogenous Opioids (Beta Endorphin and Enkephalin)

Background: Hypnoanesthesia is a state of anesthesia achieved through hypnosis techniques. Meanwhile, hypnosis is a condition in which the mind receives information without analyzing it. Hypnoanesthesia has been empirically utilized in surgery since the 18th century, but the mechanism remains unclear. Objective: This study aims to prove nociceptive pain relief due to hypnoanesthesia in minor surgery, with indications of changes in the serum levels of several excitatory and inhibitory neurotransmitters in the physiological mechanism of pain. Methods: The study subjects included patients with benign soft tissue tumors consisting of 40 people who were divided into 2 groups (treatment and control). The treatment group underwent minor surgery using hypnoanesthesia, while the control group underwent minor surgery using 2% lidocaine local anesthesia. Pain in both groups was measured by FPS (Face Pain Scale) and monitored by a vital sign monitor. Changes in the serum levels of glutamic acid, substance P, beta-endorphin and enkephalin neurotransmitters in both groups before and after the intervention were analyzed using ELISA. Results: There were no significant changes in serum levels of neurotransmitters, pre and post intervention in both groups, both excitatory neurotransmitters Glutamic Acid and Substance P and inhibitory neurotransmitters Beta Endorphins and Enkephalin (p > 0.05). Conclusion: Based on the results of the data analysis, it can be concluded that the empirical nociceptive pain relief occurred in patients who underwent minor surgery with hypnoanesthesia and there was no significant change in betaendorphin, enkephalin, glutamate acid, and substance P serum levels before and after hypnoanesthesia

The Benefits of Music Therapy on Preterm Infants in the Intensive Care Unit

This clinical study seeks to demonstrate the benefits that music therapy can provide, by the analysis of heart rate, respiratory rate, peripheral oxygen saturation and the Neonatal Facial Coding System pain scale on preterm neonates hospitalized in the neonatal intensive care unit, where they are exposed to factors which are stressful and harmful to their health. During the period between March and September 2022, each hospitalized PT neonate was submitted to a single 20 minutes music therapy session with non-classical instrumental music without voice. A total of 17 preterm neonates were included in the analysis of this study. The data collected demonstrated that music therapy was beneficial in stabilizing vital signs with an average reduction in heart rate of 12 beats per minute during the therapy (p = 0.012). Conclusion: Music therapy is capable of stabilizing vital signs such as heart rate in a single session and reducing the stress of the neonate.

Abstract P3-03-05: A randomized study assessing interventions to improve comfort during screening mammography

Abstract Background: Although screening mammography leads to an early detection of breast cancer and a reduction in breast cancer mortality, many women have apprehension about mammograms due to reported discomfort and pain [would cite the source]. A study showed that pain was the cause of non-reattendance of screening mammograms in 25-46% of reported cases by women. Despite this, there is limited research on strategies to reduce discomfort and anxiety associated with mammography screening and improve patient experience and compliance with national screening recommendations. Herein, we performed a double-blind randomized clinical study to determine if the use of local analgesia and calming music can improve patient satisfaction during routine screening mammogram. Methods: This study was designed as a double-blind randomized clinical trial with a 2 × 2 factorial design. A total of 251 patients who presented for mammographic screening were randomized to receive: breast lidocaine gel at a dose of 1200 mg or placebo gel on both breast and experience calming music or no music Patients with history of mastectomy, breast cancer or recent (within 24 hours) analgesic use were excluded. Pain was measured with a 5-point face pain scale. Benjamini-Hochberg false discovery rate was used for analysis Results: Of the 251 patients who were randomized between June 2017 and October 2019, 195 self-identified as Hispanics (77%). Median age was 58.5 years old and there were no differences in between groups. 100% were female. 99.3% presented for screening with no concerning symptoms. A total of 126 patients were randomized to music vs 125 to no Music. 79 patients in music group and 51 patients in no music group were randomized to lidocaine. Regarding pain assessment, 18.96% of patients had a pain score of 4 and 5 in the music group randomized to lidocaine gel as opposed to 10.64% to placebo gel. In the non-music group, 17.65% of patients expressed pain score of 4 and 5 to lidocaine gel vs. 18.91% to placebo gel. (P value music: 0.95, P value lidocaine: 0.93 P value music and lidocaine: 1). Patients randomized to lidocaine gel to music reported their prior mammogram to be at a pain score of 4 to 5 in 41.7% of the subjects vs 45% of patients in the no music group. (P value music: 0.45, P value lidocaine: 0.93 P value music and lidocaine: 1). Despite this, majority patients in both groups expressed no reluctance for future mammograms. Conclusion: The addition of calming music and breast lidocaine gel did not show a statistically significant difference in the level of pain perceived by patients getting screening mammography. The data appear to suggest less severe pain (pain score 4 and 5) when these strategies are combined. Further prospective trials with larger patient populations are needed to explore these interventions. Despite the perceived pain most patients were still willing to return for a mammogram the following year. Citation Format: Marcela Mazo-Canola, Heidi C. Ko, Kenneth Kist, Joel Michalek, Lillian Franco, Pamela Otto, Virginia Kaklamani. A randomized study assessing interventions to improve comfort during screening mammography [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-05.

Preoperative Anxiety and Postoperative Pain in Children with Burn Patients and Their Correlation Analysis

Background: Burn is a kind of skin tissue damage under the influence of heat source, which is a common type of accidental injury in current society. Objective: To investigate the status of preoperative anxiety and postoperative pain in children with burn patients, and to analyze the correlation between preoperative anxiety and postoperative pain. Methods: A total of 108 pediatric patients who underwent burn surgery under general anesthesia in our hospital from October 2020 to August 2021 were selected. FLACC and Facial Expression Pain Scale were used to evaluate the pain of the children, and STAI and YPAS were used to evaluate the anxiety of the children. Correlation was used to analyze the effect of preoperative anxiety on postoperative pain in burn children. Results: Preoperative anxiety and severe anxiety accounted for more than 50% of burn children, and there was a statistically significant difference in preoperative anxiety and postoperative pain between 1-3-year-old children and 4-12-year-old children. The influencing factors of postoperative pain in children with burns were analyzed, including burn area, depth of burn, and previous operations. The multivariate analysis showed that the risk factors for postoperative pain in children were age, burn area, depth of burn, preoperative anxiety of children, and parental trait anxiety, after statistical test, it shows that each influencing factor has a significant influence on postoperative pain in children (P < 0.05). In the correlation analysis of preoperative anxiety and postoperative pain in children with burns, it was shown that preoperative anxiety in children aged 1 to 3 years had a significant impact on postoperative pain of children, and the correlation analysis showed that preoperative anxiety of children with burns There was a positive correlation between anxiety score and postoperative pain (r=0.479, P=0.001). Conclusion: The incidence of preoperative anxiety in children with burn patients is high, and the postoperative pain scores are also different in different age groups. In addition, there is a current correlation between preoperative anxiety and postoperative pain in children with burn patients, and the correlation is positively correlated, that is, the higher the patient's anxiety score, the more intense the patient's postoperative pain.

Compare the level of pain using faces pain scale and colour analogue pain scale among children aged between 6 to 12 years attending in pediatric ward

Faces pain scale and colour analogue pain scale are two methods to assess the pain of the children. There many method to assess the pain of the children but mostly all the hospital is using faces pain scale to assess the pain of the children. Pain perception in children is a very controversial topic in children admitted in hospital. So the present study aims to compare faces pain scale and colour analog pain scale in children undergoing therapeutic procedure such as intravenous injection, intramuscular injection, postoperative children, venipuncture and other invasive procedure in Saveetha Medical College and Hospital. A Quantitative research approach with comparative research design was adopted to conduct the study among 60 children added between 6 to 12 years attending pediatric ward who were selected by non-probability convenient sampling technique. A semi-structured interview method was used to collect demographic data and pain is assessed using faces pain scale and colour analogue pain scale in Saveetha medical college and hospital. The result of the study shows that among 60 samples proves that the mean score of faces pain scale was 4.95±2.50 and the mean score of colour analogue scale was 4.77±2.83. The calculated paired ‘t’ test value of t = 0.747 was not found to be statistically significant which clearly infers that there was no significant difference in the pain score measured by faces pain scale and colour analogue scale among children 6 – 12 years attending pediatric ward.

Accuracy of Pain Scales in Predicting Critical Diagnoses in Non-Traumatic Abdominal Pain Cases; a Cross-sectional Study.

Accurate assessment and management of abdominal pain in the emergency department (ED) is crucial, as it can indicate potentially life-threatening conditions requiring timely treatment. This study aimed to evaluate the ability of pain scales to predict critical diagnoses in patients with non-traumatic abdominal pain. This cross-sectional study was conducted at a tertiary university hospital and involved individuals aged 15 years and above who presented to the ED with non-traumatic abdominal pain. Pain severity was evaluated using subjective pain scales, including the Numerical Rating Scale (NRS) and the Face Pain Scale (FPS), as well as objective pain scales, including the Critical Care Pain Observation Tool (CPOT) and the Non-verbal Pain Score (NVPS). The area under the receiver operating characteristic curve (AuROC) was employed to determine the discriminative ability of each pain scale to predict critical diagnosis. 264 cases with the mean age of 47.2±19.4 years were studied (53.0% male). The most common location of abdominal pain was epigastric pain (43.9%). Most patients presented with dull-aching pain, and those with critical diagnoses had more of this characteristic than those with non-critical diagnoses. (52.5% vs. 28.3%, p = 0.01). The overall median NRS, FPS, CPOT, and NVPS of included participants were 8 (interquartile range (IQR) 7-10), 8 (IQR 6-8), 3 (IQR 1-4), and 3 (IQR 2-4), respectively. Patients with critical diagnoses had a higher NVPS score than patients with non-critical diagnoses (median score of 4 vs. 3, p = 0.02). The AuROC of NRS, FPS, CPOT, and NVPS were 0.53 (95% CI: 0.45-0.62), 0.55 (95% CI: 0.46-0.63), 0.59 (95% CI: 0.50-0.68), and 0.62 (95% CI: 0.53-0.71), respectively. The correlation coefficients among these scales were considered moderately correlated or higher. In evaluating patients with non-traumatic abdominal pain, the NVPS demonstrated the highest accuracy in predicting critical diagnoses. However, all pain scales, whether subjective or objective, exhibited suboptimal performance in predicting critical diagnoses.

Evaluation of the effectiveness of photobiomodulation therapy as an alternative method to local anesthesia injection in pediatric dentistry.

The idea of receiving local anesthesia (LA) via an injection is a major source of dental fear and anxiety. In children, dental anxiety is considered the main reason for avoiding dental treatments. Moreover, there are potential complications during/after LA administration. Thus, it is necessary to search for painless, low-risk, and nonpharmacological anesthetic approaches. This study was performed to evaluate the effectiveness of photobiomodulation (PBM) therapy as an alternative method to LA injection for conventional restorative treatments in pediatric patients. This was a split-mouth randomized clinical study. The study included 15 children between 6 and 12 years old. Each child had 2 similar contralateral caries lesions in the first permanent molars in the same jaw, total (30) teeth. For each child, one tooth was treated under conventional LA injection and the other was treated under PBM-based anesthesia. The Wong-Baker's Faces Pain Scale was used for reporting the pain and discomfort levels at the end of the treatments. Data statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. Mann-Whitney U-test was used to compare between the groups. The PBM-based anesthesia group recorded a mean pain score of 2.27 ± 1.28. The conventional LA group recorded a mean pain score of 1.73 ± 0.7. The difference between the groups was not statistically significant (P = 0.168). PBM-based anesthesia may be an optional alternative to LA injection for conventional restorative treatments in children with dental anxiety, needle phobia, or special needs, and it deserves further studies and improvement.

Comparison of intranasal midazolam-fentanyl with dexmedetomidine–fentanyl as pre-medication in the paediatric age group

Intranasal midazolam-fentanyl is commonly used as pre-medication in paediatric patients, but there is a risk of respiratory depression with this combination. Dexmedetomidine is a drug that preserves respiratory function. The objective of this study was to compare the efficacy of intranasal midazolam-fentanyl and dexmedetomidine-fentanyl in paediatric patients undergoing elective surgeries. Hundred children in the age group of 3-8 yr of American Society of Anaesthesiologists physical status grade 1 were randomized into two groups- group A received intranasal midazolam (0.2 mg/kg)-fentanyl (2 μg/kg) and group B received intranasal dexmedetomidine (1 μg/kg)-fentanyl (2 μg/kg) 20 min before induction of general anaesthesia. Heart rate and SpO2 were monitored. Sedation score, parental separation and response to intravenous cannulation were seen after 20 min. Children were monitored for 2 h for post-operative analgesia by Oucher's Facial Pain Scale. Sedation scores were satisfactory in both groups, although children in group A were more sedated than in group B. Parental separation and response to intravenous cannulation were comparable in both the groups. The two groups were also haemodynamically comparable intraoperatively. Post-operative heart rate was also comparable at all-time intervals in both the groups except for heart rate at 100 and 120 min which were more in group A. Group A experienced more post-operative pain as assessed by Oucher's Facial Pain Scale as compared to group B. Children receiving intranasal dexmedetomidine-fentanyl had better post-operative analgesia as compared to those who received intranasal midazolam-fentanyl. Both intranasal midazolam with fentanyl and intranasal dexmedetomidine with fentanyl provided satisfactory sedation. Both groups were comparable in separation reaction and response to intravenous cannulation with better post-operative analgesia in children receiving intranasal dexmedetomidine-fentanyl.

Comparative evaluation of quality of obturation and instrumentation time using different file systems in deciduous molars: A randomised clinical trial

Introduction: Multiple systems are available for chemo-mechanical preparation during pulpectomy, but an evolution of the exclusive paediatric rotary single file system has opened new doors in paediatric endodontics. The aim was primarily to compare the quality of obturation and instrumentation time and secondarily to report pain perception between manual files and rotary file systems in deciduous molars. Materials and Methods: Pulpectomy was performed in 60 carious mandibular primary molars indicated for pulpectomy in children aged 4–8 years after considering the selection criteria. These teeth were divided randomly into three groups of 20 each, wherein canals were prepared using Hand K files in Group 1, HeroShaper Rotary File System in Group 2 and Kedo S Square single paediatric rotary file in Group 3. The quality of obturation was assessed using intraoral radiographs, and instrumentation time was recorded in seconds using a stopwatch. Pain during instrumentation was assessed using Wong Baker’s FACES Pain Scale. Collected data were subjected to analysis using the Chi-square test, one-way ANOVA and Honestly Significant Difference posthoc test. Results: Mean instrumentation time was least for the Kedo-S Square file system (57.47 ± 9.26), followed by the HeroShaper group (99.6 ± 23.62), and maximum time was recorded for Hand files (255.99 ± 46.20), and this difference was statistically significant (P = 0.00), whereas there was no significant difference regarding the quality of obturation and pain perception between the three groups. Conclusion: As the Kedo S Square system showed the fastest canal preparation, it can be recommended for pulpectomy procedures in primary teeth because the length of appointment is directly proportional to the behaviour of the child.

Efficacy of benzocaine and lidocaine bioadhesive patches in various minor oral surgical procedures in children - An evaluative study.

The key to successful management of a child in the dental clinic depends greatly on providing painless anaesthesia. Topical anaesthesia using bioadhesive patches may be a breakthrough in this field. The purpose of the study was to compare the efficacy of Benzocaine and Lidocaine bioadhesive patches in reducing pain associated with various minor oral surgical procedures in children. Hundred subjects, aged 6-9 years, requiring various minor oral surgical procedures such as extractions of primary teeth, nerve blocks, mucocele excision or drainage of abscesses were divided equally into Groups 1 and 2. In Group 1, custom fabricated Benzocaine patches were placed for 5 minutes at the target site prior to the procedure, and in Group 2, Lidocaine patches were used in the same manner. Each subject completed a visual analogue scale (VAS) and Wong-Baker Faces pain scale (FPS) after each procedure. Pulse rate and saturation of peripheral oxygen were assessed using pulse oximeter. The duration of the study was from September 2014 to September 2015. The statistical analysis was done using paired t test, ANOVA and Bonferroni post hoc analysis. P value less than 0.05 were considered as statistically significant. A significant difference in pain scores was observed favouring the use of Benzocaine over Lidocaine patches (P < 0.05). However, no significant differences in pulse oximeter readings were observed. A statistically significant reduction in pain rating scores was observed in the Benzocaine group after a five-minute application of the patch.

Assessment of pain in paediatric dental patients during administration of local anesthesia with and without the use of audiovisual distraction

Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6-8-year-old children. In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6-8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance. Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction. Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

Evaluation of the effectiveness of sucrose versus xylitol application in minimizing pain related to dental injection in 5-7-year-old children - A randomized controlled pilot study.

Oral application of sweet-tasting solutions has found to be effective in minimizing pain on dental injection in children. Xylitol has never been tested in this regard. The aim of this study was to compare the effectiveness of prior application of sucrose versus xylitol solution in minimizing pain on dental injection in 5-7-year-old children. This study was a randomized controlled clinical trial. Informed consent was taken. A total of 30 children who required maxillary buccal infiltration injection were selected. The children were randomly allocated into the sucrose group, xylitol group, or control group by lottery method. In the sucrose and xylitol groups, 30% sucrose or 30% xylitol solution was applied on the lateral surface of the tongue for 2 min. In the control group, distilled water was applied. In all the groups, the topical anesthetic was applied at the site of injection followed by buccal infiltration. A video was taken during injection, and the sound eye-motor (SEM) scale was recorded by a blinded examiner. Patients were asked to self-evaluate using the Wong-Baker Faces Pain Scale (WBFPS). Mann-Whitney test was used to analyze the data. There was a statistically significant difference in the WBFPS and the SEM score between the sucrose and the control group (P < 0.05) and the xylitol and control group (P < 0.05). No statistically significant difference was found between the sucrose and xylitol group. The application of xylitol solution before dental injection was as effective as sucrose solution in minimizing pain during the injection.

The comparative effects of ball squeezing and cartoon watching in pain management in children during intramuscular injection: A randomized control trial

This study was designed as a randomized controlled trial to investigate the comparative effect of ball squeezing and watching cartoons on pain management in children during intramuscular injection. The population of the study was comprised of 6-12 years old children who came to emergency for intramuscular injection. Power analysis was performed by G*Power program. Approximately 147 protocols completed with 6-12 years old children (each group 49 children). In the study, a questionnaire including child and socio-demographic characteristics their experiences of hospitalization data and Facial Pain Scale- Revised (FPS-R), Visual Analog Scale (VAS), and ball (for squeezing) were used. According to the results of the study, the FPS-R score during the procedure was the lowest in the stress ball group and was statistically significant (p˂0.05). The lowest VAS scores during the procedure the lowest score was in the stress ball group and the differences between the relevant groups were statistically significant (p˂0.05). It was determined that squeezing the ball and watching cartoons were effective in reducing pain during injection, however, the ball squeezing group had the lowest pain level. Among non-pharmacological methods, ball squeezing can be preferred as a practical and effective method, especially by pediatric nurses, in reducing pain during intramuscular injection in children.

GAMBARAN DERAJAT NYERI PUNGGUNG PADA IBU HAMIL TRIMESTER III

Pregnancy brings physical and psychological changes which can cause discomfort, especially in the third trimester, such as frequent urination, breathing problems, back pain, difficulty defecating, difficulty sleeping, dyspnea, discomfort in the perineum, leg muscle cramps, varicose veins, edema in the legs, fatigue, mood changes, and anxiety. The problem of back pain during pregnancy often occurs, especially in the 3rd trimester. Low back pain during pregnancy has an impact on the psychological, social life, and quality of life of pregnant women. This study aims to determine the characteristics and degree of back pain in third trimester pregnant women. This research is a descriptive research and has been done on the 07 February -18 February 2022at the Kenanga Poskesdes, Pal IX Village, Sub-district Sungai Kakap, District Kubu Raya. The sampling technique used non probability sampling, with sample is 15 pregnant women at third trimester. Measuring the degree of pain used the Faces Pain Scale Revised (FPS-R) questionnaire. The results of the study found that 74% were mothers aged 20-35 years, 67% had basic education, working mothers (87%), and multigravida (67%) The most common complaint experienced was moderate degree back pain with a total of 60% of respondents, this is what causes pregnant women to tire easily and requires treatment for this pain in the form of light exercise movements such as pregnancy exercise.

ÇOCUKLARDA İNTRAVENÖZ KANÜL SIRASINDA AĞRI VE KORKUYU AZALTMADA ÜÇ FARKLI YÖNTEMİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI: RANDOMİZE KONTROLLÜ BİR ÇALIŞMA

This study investigates the effects of squeezing a soft ball, using a kaleidoscope, or blowing bubbles during intravenous cannulation on the pain and fear of children between the ages of 4 and 6. This study is a randomised controlled study. It was conducted in the pediatric emergency service of a university hospital in the east of Turkey. In the study, there were 30 children in the soft ball group, 30 children in the kaleidoscope group, 30 children in the bubbles group, and 30 children in the control group. The Descriptive Information Form, the Faces Pain Scale–Revised, and the Children’s Fear Scale were used in data collection. Four groups included in the study were found to be similar. It was found that the children in the soft ball, kaleidoscope, and bubbles groups experienced less pain and fear than the children in the control group during an intravenous cannulation procedure, and the difference in score between the groups was found to be statistically significant. In the study, it was found that squeezing a soft ball, using a kaleidoscope, and blowing bubbles during an intravenous cannulation procedure in a pediatric emergency service were effective in reducing the pain and fear of children.

Effectiveness of stress ball and relaxation exercises on polymerase chain reaction (RRT-PCR) test-induced fear and pain in adolescents in Türkiye

PurposeThis study aimed to determine the effectiveness of stress balls and relaxation exercises in relieving PCR test-induced fear and pain in adolescents. Design and methodsA randomized controlled experimental study with a parallel-group design was conducted. The sample size was determined by G*Power analysis, and 32 adolescents were included in each group accordingly. The data were collected using the Adolescent and Parent Information Form, The Children's Fear Scale, and The Wong-Baker Faces Pain Scale. Descriptive statistics, t-test, paired t-test, ANOVA, and Tukey's forward analysis were used to analyze the data. ResultsThe mean age was 14.93 ± 2.07 years for the adolescents, 43.58 ± 4.50 years for the mothers, and 48.25 ± 4.92 years for the fathers. Adolescents were stratified according to age, gender, and fear of invasive procedures, and homogeneity was ensured in their distribution to the groups. The pre-procedural level of fear was moderate in each group with no significant difference (p > 0.05). However, a significant difference was found between the groups in terms of both post-procedure levels of fear and pain. The pre-procedural fear of the adolescents in the control group (3.91 ± 0.29) did not change much after the procedure (3.91 ± 0.30), while there was a decrease in the other groups. The least post-procedure fear (0.09 ± 0.29) and pain (0.44 ± 0.67) were found to be in the relaxation exercise group. Conclusions and practice implicationsRelaxation exercise is the most effective method to reduce fear and pain during the PCR procedure. It is recommended to use it during the PCR procedure for being easily accessible, applicable, and cost-effective.Clinical Trials ID: NCT05250544.

ROLE OF HOMOCYSTEINE IN DEVELOPMENT OF ABDOMINAL PAIN IN PATIENTS WITH IRRITABLE BOWEL SYNDROME AND CONSTIPATION

Introduction. Irritable bowel syndrome with constipation poses a serious medical and social problem. Studying the pathogenetic mechanisms of irritable bowel syndrome with constipation may improve therapeutic approaches and patient’s quality of life.&#x0D; The aim of this study is to investigate the homocysteine role in the development of abdominal pain syndrome in patients with irritable bowel syndrome and constipation, taking into account body mass index.&#x0D; Subjects and methods. The study involved 55 patients with functional bowel disorders, who were divided into 2 groups: group I (n=27) included patients with functional constipation; II group (n=28) involved patients with irritable bowel syndrome and constipation. The average age of patients in group I was 35.7±8.63 years, in group II – 34.50±9.06 years, the ratio of men and women was 7(25.9%) / 20(74.1%) and 10 (35.7%) / 18(64.28%), respectively. A modified faces pain scale was used to assess pain intensity. Height, weight, and waist circumference were measured, body mass index was calculated according to formula: body mass index = weight (kg)/height (m2). The homocysteine level in the blood serum was measured.&#x0D; Results. Abdominal obesity with the waist circumference greater than 88 cm for women and greater than 102 cm for men was recorded in 6 (21.42%) patients with irritable bowel syndrome and constipation and in 4 (14.81%) patients with functional constipation. The severity of pain and meteorism according to the modified faces scale in patients with irritable bowel syndrome with constipation were respectively 2.4 and 1.7-fold (р˂0.0001) higher than the respective parameters in the patients with functional constipation.&#x0D; The content of homocysteine in the blood serum in the patients with irritable bowel syndrome and constipation was 1.9-fold (р˂0.0001) higher than in the patients with functional constipation. Increased homocysteine level led to the increase in the risk of developing irritable bowel syndrome and constipation (RR=3.61; 95%CI 1.37–9.52; p&lt;0.01). It is important to stress that the serum homocysteine level in the patients with irritable bowel syndrome with constipation was directly correlated with the pain severity assessed by the modified faces pain scale (r=+0.9; p=0.0001).&#x0D; Conclusion. The severity of abdominal pain and meteorism in patients with irritable bowel syndrome and constipation is associated with the homocysteine level in the blood serum.

Effects of ultrasound guided caudal epidural and transversus abdominis plane block on postoperative analgesia in pediatric inguinal hernia repair surgeries

Ultrasound guided caudal epidural block (CEB) and transversus abdominis plane block (TAPB) are two techniques which are used for pain management after inguinal hernia surgeries (IHR). CEB is accepted as gold standard for lower abdominal surgeries while TAPB is more popular. It is aimed to compare ultrasound guided CEB and TAPB for postoperative pain scores, additional analgesic requirement and chronic pain development in pediatric bilateral open IHR. Seventy patients aged 1-7 years undergoing bilateral open IHR were included in this prospective, randomized, double-blinded study. Patients were randomized into group T (Bilateral TAPB) and group C (CEB). Postoperative FLACC (Face, Legs, Activity, Cry, Consolability) scores were evaluated for pain density. Additional analgesic requirement, length of hospital stay was also recorded. Chronic pain is evaluated within a subgroup by using "revised Bieri faces pain scale" in the postoperative second month. Postoperative 15th, 30th, 45th min, first, second hour FLACC scores were similar in both groups (P>0.05). In group C, FLACC scores at postoperative sixth and 24th were significantly higher than group T (1 (0-5) vs 0 (0-2); 1 (0-3) vs 0 (0-2), respectively; P<0.001). Additional analgesic requirement in the postoperative 24h was found to be statistically higher in Group C (56.7%) than in Group T (20%) (P<0.01). Chronic pain development did not differ between the groups (P>0.05). Length of hospital stay was found to be shorter in patients in Group T compared to patients in Group C [10 (5-14) vs 16 (5-18) hours, respectively; P<0.01)]. Our results exhibited that TAPB and CEB for bilateral IHR have similar early analgesic efficacy in children. However; CEB patients experienced higher FLACC scores at the postoperative sixth and 24th hours, and the need for additional analgesics was higher and the length of hospital stay was longer comparing to TAPB. Of note, chronic pain was not observed in any of our subgroup patients (n=21) who are older than four years. For bilateral IHR, US-guided CEB and TAPB have similar analgesic efficacy in the first six hours, postoperatively, However, TAPB appears to be slightly superior than CEB in terms of subacute pain and length of stay which is still not clinically distinctive.

Effect of L. reuteri on bowel movements in children aged 6months to 4 years: A double-blind randomized controlled trial.

Chronic constipation is common in children and often requires prolonged laxative treatment. Preliminary studies suggest that the probiotic Limosilactobacillus reuteri (L. reuteri) may be useful in treating constipation in children, but these preliminary results need to be replicated. The objective of this study was to assess the efficacy of L. reuteri in infants and young children with chronic functional constipation. A prospective double-blind randomized placebo-controlled trial was conducted in 5 pediatric departments in France between June 2017 and June 2021. In all, 49 patients-ages 6 months to 4 years, and suffering from chronic constipation per Rome IV criteria-were randomly allocated to the test and control groups. For 4 weeks, all were orally administered 5 daily drops of the test (L. reuteri DSM 17938 at 108 colony-forming units per day) or control (placebo) treatment, respectively. Participants were clinically assessed at 4 and 8 weeks. Parents were asked to daily record the number of spontaneous bowel movements (SBMs), stool consistency, and the use of any additional laxatives. Informed consent was obtained from parents of all recruited patients, and the study was approved by both an ethics committee and the French National Agency for Medicines and Health Products Safety (ANSM). The study is registered on ClinicalTrials.gov (NCT03030664). The change in SBMs relative to baseline was greater in the control group at week 4 (control: 0.27 ± 0.5; test: 0.23 ± 0.5; P = 0.01) and in the test group at week 8 (control: 0.26 ± 0.4; test: 0.22 ± 0.5; P = 0.03). At week 4, the groups did not differ in number of responders (≥3 stools per week, with no non-retentive fecal incontinence), use of rescue medication, scoring of pain during defecation (Faces Pain Scale-Revised), or stool consistency (Bristol Stool Form Scale). This double-blind randomized controlled trial did not confirm the efficacy of L. reuteri for treatment of chronic functional constipation in young children.