Objective Pain Scale Research Articles

Emergency pain management: A Canadian Association of emergency Physicians (CAEP) consensus document

Pain is the most common presenting complaint heard in Emergency Medicine, yet it is poorly controlled. Evaluation of this pain should be with use of objective pain scales completed by the patient, not relying on physician impression. Treatment modalities available in the Emergency Department, a review of medications and their dosing as well as specifics to pediatric pain management are presented. The final section reviews situation or diagnosis specific pain control: headaches, renal colic, polytrauma victims, abdominal pain, soft tissue injury and acute arthritis. These recommendations are based on a Canadian Association of Emergency Physicians (CAEP) consensus conference held in April 1993. The literature was reviewed extensively and used as the basis for the consensus workshops and discussion. At the writing of the consensus paper, however, no specific ideas were borrowed from any one article. The appended bibliography is suggested reading, selected from the larger literature review. There are to date few controlled multi centre trials in overall pain management that would allow guidelines to be produced.

Epidural Versus Patient-Controlled Analgesia with Morphine for Postoperative Pain After Orthopaedic Procedures in Children

Summary: We compared epidural and patient-controlled analgesia using morphine for pain relief during the first 30 h after orthopaedic surgery to examine whether intermittent epidural morphine (EM) offered a clinical advantage over patient-controlled analgesia in children. Forty patients were assigned randomly to receive either EM or morphine by the patient-controlled analgesia technique. In the special care unit, trained observers evaluated the patient's level of postoperative pain with a standardized objective pain scale. The differences in pain scores among the groups were compared. The two groups were not significantly different in age, weight, duration of operation, or anesthesia. There was no significant difference in quality of pain relief except for the amount of medicine required to control postoperative pain and the incidence of side effects between the two groups.

Epidural Versus Patient-Controlled Analgesia with Morphine for Postoperative Pain After Orthopaedic Procedures in Children

We compared epidural and patient-controlled analgesia using morphine for pain relief during the first 30 h after orthopaedic surgery to examine whether intermittent epidural morphine (EM) offered a clinical advantage over patient-controlled analgesia in children. Forty patients were assigned randomly to receive either EM or morphine by the patient-controlled analgesia technique. In the special care unit, trained observers evaluated the patient's level of postoperative pain with a standardized objective pain scale. The differences in pain scores among the groups were compared. The two groups were not significantly different in age, weight, duration of operation, or anesthesia. There was no significant difference in quality of pain relief except for the amount of medicine required to control postoperative pain and the incidence of side effects between the two groups.

A comparison of wound instillation and caudal block for analgesia following pediatric inguinal herniorrhaphy

Regional analgesia, in a variety of forms, has been shown to afford effective postoperative pain relief after pediatric inguinal hernia repair. This study compares the efficacy of wound instillation with 0.25% bupivacaine (n = 20), caudal block with 0.25% bupivacaine (n = 35), and a control group (n = 15). Outcome parameters examined include total operating room time, time to extubation, postoperative objective pain scales, and requirement for supplemental analgesics. Patients who received caudal blocks had significantly decreased emergence times ( P < .002), exhibited fewer pain-related behaviors postoperatively ( P < .0025), and required less narcotic to maintain normal hemodynamics ( P < .05). Operating room time was not statistically different between the three groups. The use of perioperative analgesic blocks resulted in quicker awakening, a more comfortable postoperative course, and potentially earlier discharge from same-day surgery.

Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy

Prophylactic administration of analgesics before surgery can decrease the intraoperative anaesthetic requirement and decrease pain during the early postoperative period. In a double-blind, placebo-controlled study involving 90 healthy ASA physical status I or II children undergoing bilateral myringotomy, we compared the postoperative analgesic effects of oral acetaminophen and ketorolac, when administered 30 min before induction of anaesthesia. Patients were randomized to receive saline (0.1 ml.kg-1), acetaminophen (10 mg.kg-1) or ketorolac (1 mg.kg-1) diluted in cherry syrup to a total volume of 5 ml. Anaesthesia was induced and maintained with halothane and nitrous oxide via a face mask. Postoperative pain was assessed by a blinded observer using an objective pain scale. The three study groups were similar with respect to demographic data, duration of anaesthesia and surgery, induction behaviour, oxygen saturation, incidence of postoperative emesis and, recovery times. The ketorolac group had lower postoperative pain scores and required less frequent analgesic therapy in the early postoperative period compared with the acetaminophen and placebo groups. In contrast, there were no differences in pain scores or analgesic requirements between the acetaminophen and the placebo groups. We conclude that the preoperative administration of oral ketorolac, but not acetaminophen, provided better postoperative pain control than placebo in children undergoing bilateral myringotomy.

Reliability of an objective pain scale in children

Reliability of an objective pain scale in children

Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients

The purpose of this study was to determine if the timing of caudal block placement in relation to surgery affected either the duration of postoperative pain relief or the discharge time in children undergoing brief ambulatory surgical procedures. Forty ASA physical status I or II children ages 18 mo to 11 yr were randomly assigned to one of two groups. Group 1 patients received a caudal block with 0.5 ml.kg-1 of bupivacaine 0.25 per cent following the induction of anaesthesia but before the onset of surgery. Group 2 patients received a similar block at the completion of surgery but before emergence from general anaesthesia. An experienced observer, who was not aware of the timing of block placement, observed all patients from arrival to the post-anaesthetic recovery room until discharge from the ambulatory surgery unit. Pain was assessed at five-minute intervals using an Objective Pain Scale. No statistically significant differences were noted between Group 1 and Group 2 patients with regard to their postoperative pain/discomfort scores, the need for postoperative narcotic analgesia, or the time required for either group to meet standard discharge criteria. It is concluded that the duration of postoperative analgesia is not impaired by placing the caudal block prior to the start of a brief surgical procedure.

A Comparison Between Bupivacaine Instillation Versus Ilioinguinal/Iliohypogastric Nerve Block for Postoperative Analgesia Following Inguinal Herniorrhaphy in Children

This study compared the postoperative pain relief provided by simple instillation of bupivacaine into a hernia wound with that provided by ilioinguinal/iliohypogastric (IG/IH) nerve block. Sixty children undergoing inguinal hernia repair under general anesthesia were randomized to receive 0.25 ml/kg of 0.25% bupivacaine for either IG/IH nerve block or up to 0.5 ml/kg of the same solution for instillation nerve blocks. In the postanesthesia care unit (PACU), a trained blinded observer evaluated the patient's level of postoperative pain using a standardized 10-point objective pain scale. Fentanyl 1-2 micrograms/kg was administered intravenously to any child scoring 6 or more points on the pain scale. The difference in pain scores among the two groups were compared. The two groups were not significantly different in age, duration of surgery, or anesthesia. There was no significant difference between patients who received the two treatment modalities in their pain scores, analgesic requirements in the PACU, recovery times, and discharge times. These results demonstrate that the simple instillation of local anesthetics into a wound provides postoperative pain relief following hernia repair, which is as effective as that provided by intraoperative IG/IH nerve block.

POSTOPERATIVE PAIN RELIEF IN CHILDREN FROM THE PARASCALENE INJECTION TECHNIQUE

Nineteen pediatric patients aged 6 months to 12 years scheduled for elective upper extremity surgery were randomly assigned to receive either a parascalene block or sham injection. Both groups received a potent inhalational agent for operative anesthesia. At completion of surgery, the treatment group received an injection of 0.5 ml/kg 0.25% bupivacaine with 1:200,000 epinephrine into the brachial plexus via the parascalene approach with the aid of a nerve stimulator; the control group received a subcutaneous needle puncture only. Patients in the parascalene group had superior postoperative analgesia, as evidenced by significantly less opioid requirement in the first 12 postoperative hours and by significantly lower scores on an objective pain scale. We found the parascalene approach to the brachial plexus a simple and reliable analgesic technique in anesthetized children.

Caudal ropivacaine and bupivacaine for postoperative analgesia in infants undergoing lower abdominal surgery.

Objective:To compare the postoperative analgesic efficacy of ropivacaine 0.175% and bupivacaine 0.175% injected caudally into infants for lower abdominal surgery.Methods:Eighty infants, aged 3-12 months, ASA I-II scheduled to undergo lower abdominal surgery were randomly allocated to one of the two groups: Group R received 1ml.kg-1 0.175% ropivacaine and Group B received 1ml.kg-1 0.175% bupivacaine via caudal route. Postoperative analgesia, sedation and motor block were evaluated with modified objective pain scale, three-point scale and modified Bromage scale respectively. Postoperative measurements including mean arterial pressure (MAP), heart rate (HR), pain (OPS), sedation and motor block score were recorded for four hours in the postoperative recovery room. Parents were contacted by telephone after 24 hours to question duration of analgesia and side effects.Results:No significant differences were found among the groups in demographic data, MAP, HR, OPS and sedation scores during four hours postoperatively. The duration of analgesia was 527.5±150.62 minutes in Group R, 692.77±139.01 minutes in Group B (p=0.004). Twelve (30%) patients in Group R, 16 (40%) patients in groupB needed rescue analgesics (p=0.348). Rescue analgesics were administered (1 time/2 times) (9/3) (22.5/7.5%) in Group R and 16/0 (40/0%) in Group B, where no statistically significant difference was determined between the groups (p=0.071). Motor blockade was observed in 7 (17.5%) patients in Group R, and 8 (20%) patients in Group B (p=0.774).Conclusion:This study indicated, that a concentration of 0.175% ropivacaine and 0.175% bupivacaine administered to the infants via caudal route both provided effective and similar postoperative pain relief in infants, who underwent lower abdominal surgery.