Pain Management In Pediatric Patients Research Articles

Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models

BackgroundThoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population.MethodsA retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity.ResultsGender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week.ConclusionsThe study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.

Suprascapular nerve peripheral nerve stimulation for pediatric cancer pain: a case series.

Aim: Despite the growing evidence supporting the use of peripheral nerve stimulation (PNS) for cancer pain in adults, it is underutilized in the pediatric oncology population. Method: We describe the use of temporary, percutaneous PNS for pain management in pediatric patients suffering from cancer related pain. Results: Two adolescent patients underwent an ultrasound-guided suprascapular nerve PNS placement utilizing the percutaneous 60-day therapy system. Both patients reported approximately 60% pain relief during the therapy, as well as up to 90days post lead removal. Conclusion: PNS may play a crucial role in the pediatric oncology population. Further studies are warranted to investigate the efficacy and safety of PNS for various cancer-related pain conditions in pediatric populations.

Pain Management in Pediatric Patients: Evidence-Based Practices and Future Directions for Pediatric Surgical Nurses

This article provides an overview of managing pain in the pediatric population for the surgical nurse. Proper assessment of pediatric pain, newborn to age 18, is reviewed, including appropriate pain scales and self-report of pain. Pain management, including pharmacological and nonpharmacological approaches, is stated. Innovative practices such as virtual reality and educational tool kits for families are reviewed. Special considerations in the pediatric population, including undertreatment of pain in infants, preprocedural pain treatment, and postoperative pain, are included. The importance of educating, aligning expectations, and communicating among the healthcare team, patients, and families is discussed.

Utilizing Peripheral Nerve Blocks for Pain Management in Pediatric Patients during Embolization and Sclerotherapy for Vascular Malformations.

Vascular anomalies are a diverse group of abnormal blood vessel developments that can occur at birth or shortly afterward. Embolization and sclerotherapy have been utilized as a treatment option for these malformations but may cause moderate-to-severe pain. This study aims to evaluate the utilization of peripheral nerve blocks in opioid consumption, pain scores, and length of stay. A retrospective chart review was conducted at the UPMC Children's Hospital of Pittsburgh for all patients who underwent embolization and sclerotherapy between 2011 and 2020. Patient data were collected to compare opioid consumption, pain scores, and length of stay. In total, 854 procedures were performed on 347 patients. The morphine milligram equivalent per kilogram mean difference between groups was 0.9 (0.86, 0.95) with a p-value of <0.001. The pain score mean ratio was -1.17 (-2.2, -0.1) with a p-value of 0.027. The length of stay had an incident rate ratio of 0.94 (0.4, 2) and a p-value of 0.875. By decreasing opioid consumption and postoperative pain scores, peripheral nerve blocks may have utility in patients undergoing embolization and sclerotherapy while not clinically increasing the length of stay for patients. Their use should be individualized and carefully discussed with the interventional radiologist.

Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries: A systematic review.

Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.

Pain Management Throughout Pediatric Laparoscopic Appendectomy: A Systematic Review.

Opioid-related fatalities are a leading cause of accidental death in the United States. Appendicitis is a common cause of abdominal pain in children and adolescents. The management of pain throughout the laparoscopic appendectomy (LA) in the pediatric population is a critical concern. This study aimed to evaluate trends in analgesic use and patient satisfaction following LA, with a focus on reducing the reliance on opioids for pain management. From 2003 to 2023, 18258 articles were filtered for all types of analgesic use with LA. The publications were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 19 studies were included for analysis and review. The study included peer-reviewed experimental and observational studies involving individuals under 18 years. Pain management strategies varied across studies, involving a combination of analgesics, nerve blocks, and wound infiltrations. Analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids were administered before and after surgery. Some studies implemented patient-controlled analgesia (PCA) pumps. Other studies explored non-pharmacological interventions like magnetic acupuncture. The results showed a reduction in the need for postoperative analgesics in patients treated with LA, particularly when using non-opioid medications and novel analgesic techniques. Pediatric patients who received gabapentin reported lower opioid use, shorter hospital stays, and high satisfaction rates. However, the reliance on opioids remained significant in some cases, particularly among patients with peritonitis who required more morphine. Pain management in pediatric patients is multifaceted, involving preoperative and postoperative analgesics, nerve blocks, and PCA pumps. Efforts to improve pain management following pediatric LA while reducing opioid reliance are essential in the context of the ongoing opioid epidemic. The findings from this study highlight the potential benefits of non-opioid analgesics, nerve blocks, and alternative methods for managing postoperative pain in <18 appendectomy patients. Further research and standardization of pain management protocols are needed to ensure optimal patient outcomes and minimize the risk of opioid-related complications.

Retrospective Analyses of Sacral Erector Spinae Plane Blocks in Pediatric Patients

Objective: The erector spinae plane block (ESPB) was first described in 2016. Recently the use of ESPB at the sacral levels was defined for adult surgeries, and a modification of the technique for pediatric surgeries, with the claim that it could replace caudal blocks, was described by our clinic. Methods: This retrospective cohort study was approved by the institutional ethical committee of Kocaeli University Hospital (GOKAEK-2021/6.04). The data were obtained from the registry of regional anesthesia saved in the department. Pre- and perioperative data regarding age, height, weight, American Society of Anesthesiologist classification, surgery duration, and anesthesia duration during the perioperative period were collected. US-guided S-ESPB was successfully applied to 16 patients included in the retrospective study. The registry of regional anesthesia data includes detailed information on block performance, postoperative pain severity, and complications in the early postoperative period (for at least 24 h). Results: 16 pediatric patients were included in the retrospective study. The mean age of the patients was 21,5 months. The mean weight of the patients was 13,1kg. In the postoperative 24-hour follow-up, one patient had a The Face, Legs, Activity, Cry, Consolability (FLACC) score greater than 4 in the PACU. None of the patients were observed to have postoperative complications. Conclusions: To our knowledge, this study is the first to retrospectively investigate the efficacy of the S-ESPB in pain management in pediatric patients. The sacral ESPB appears to be an effective option for postoperative pain in pediatric patients undergoing lower abdominal surgery.

Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

Background: Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve both clinical outcomes and cost savings in various perioperative settings. Our study focuses on the effects of ERAS protocol in craniomaxillofacial surgery in a single institution within 2 years leading up to and following implementation. The purpose of this research is to quantify the changes in effective pain management in pediatric patients undergoing craniomaxillofacial procedures before and after our ERAS protocol, which did not include IV acetaminophen. We hypothesize that ERAS protocol, even without IV acetaminophen, will provide effective pain management while decreasing the opioid use4 in the perioperative and postoperative period without associated complications from NSAID therapy. Methods: A retrospective chart review was conducted on 137 pediatric patients that underwent craniofacial surgery between July 1, 2014, and June 30, 2020. Patients were divided into 2 cohorts: Pre-ERAS and Post-ERAS with the implementation of ERAS on July 1, 2017. Results: Post-ERAS cohort showed increased NSAID use in the preoperative and postoperative period for both IV and PO ( P = .006 and P = .0064). Morphine use showed no immediate changes until a year after implementation with a statistically significant reduction ( P = .0051). When stratified by procedure type, IV NSAID (Ketorolac) use increased in Palatoplasty procedures ( P = .0154) while PO NSAID (Ibuprofen) use increased in Cleft Lip Repair ( P = .0224). Conclusion: ERAS protocol implementation can provide benefit for pediatric patients undergoing craniomaxillofacial surgery by decreasing opioid use, even in the absence of IV acetaminophen. Outcomes may potentially be delayed in the immediate post-implementation period. This study can add to the expanding literature for the use of ERAS protocol in craniomaxillofacial surgical settings. Further studies can include analyzing potential barriers to implementation and future complications related to ERAS long term outcomes.

Nurses’ Experiences of Providing Pain Management to Pediatric Patients in Indonesia

Inadequate pain management has been a worldwide concern for hospitalized children. Little is known about pain management for pediatric patients in Indonesia. This study explored nurses' experiences providing pain management in the pediatric unit. A qualitative descriptive approach was used. Fifteen nurses who worked in the pediatric intensive care unit and the pediatric, maternal-child, and general wards of the Islamic Teaching Hospital in Indonesia were interviewed by telephone due to the COVID-19 pandemic period. Based on content analysis, five themes were extracted from the data: ways to assess pain vary, working with colleagues, attitudes toward pain-relief strategies, enhancing parental understanding and involvement, and desire to have age-specific pain management training for pediatric patients. The results revealed issues nurses face in real contexts. Pediatric nurses need pain management training to improve their knowledge and skills.

Practice of Postoperative Pain Management in Under-Five Children in A Tertiary Hospital: A Prospective Crossectional Study.

Despite advancements in pain management, children have remained undertreated for postoperative pain. Data regarding the practice of post-operative pain management in paediatric patients remains less available in the developing world. This study was aimed at evaluating practice of postoperative pain management in under five children. A prospective cross sectional one-year study was conducted on all paediatric patients who underwent major paediatric surgical procedures from February 1, 2020 to January31, 2021, at a tertiary hospital in Addis Ababa, Ethiopia. A single type of analgesic medication was used in 67.1% patients. Analgesic medications were administered on standing base only in 64.4% of patients. Patients' charts had no documentation of pain assessment both in the neonatal intensive care units and wards.32.89 % of assessed patients had moderate to severe pain record. Significant number of patients suffer from postoperative pain because of absence of proper pain assessment and inadequate administration of analgesic medication.

Acupuncture for Pain Management in Pediatric Patients with Sickle Cell Disease.

Pain management in an acute vaso-occlusive episode for pediatric patients with sickle cell disease (SCD) is challenging and often is focused on opioids, IV fluids, regional anesthesia, ketamine infusions, and non-steroidal anti-inflammatory drugs (NSAIDs). Acupuncture has long been studied as an effective method of pain relief, although the use of acupuncture in pediatric patients with SCD during an acute vaso-occlusive pain episode is vastly understudied. This article provides a review of current research regarding the use of acupuncture as a pain treatment strategy for pediatric patients with SCD experiencing acute pain. A literature review of scientific papers published within the last ten years was conducted on the topic. Five primary literature articles on acupuncture for pain management in pediatric patients with SCD were reviewed. Acupuncture is feasible and acceptable, with statistically significant findings for effectiveness as an adjunct treatment for pain in this setting. It is concluded that acupuncture is a promising and understudied therapy for the treatment of pain during an acute pain episode in pediatric patients with SCD. Hopefully, this paper stimulates interest in this specific area of medicine and prompts future research studies to be conducted to reveal conclusive outcomes.

Utilization of Pediatric Standing Orders by Triage Nurses in a Free-Standing Emergency Department.

Pediatric pain-related complaints continue to be a common presenting factor of most emergency departments (EDs). Studies have shown that several barriers in assessing and treating pediatric pain exist, including nursing knowledge regarding appropriate pain level assessment. This quality improvement study aimed to provide and evaluate specific education regarding pediatric pain management for free-standing ED triage nurses to expedite medication administration during the triage phase of an ED visit. This pre/post-test intervention study was used to measure whether the education provided to nurses working in a primarily adult patient free-standing ED increased the utilization of triage standing orders related to pediatric pain management. Paired sample t-tests results indicated a statistically significant increase (p = .000) in the percentage of patients that received pain medication during the triage phase of an ED visit after specific education was provided to triage nurses. Free-standing ED triage nurses are more likely to follow and implement triage standing orders if education explicitly related to pain management in pediatric patients has been provided. Pediatric pain management education should be revisited annually to re-educate nurses on the importance of early interventions.

Pain and pain management in children and adolescents receiving hospital care: a cross-sectional study from Sweden.

BackgroundPain is a common symptom in children receiving hospital care. Adequate pain management in paediatric patients is of the utmost importance. Few studies have investigated children’s own experiences of pain during hospitalization.AimTo describe the prevalence of pain, self-reported pain intensity at rest and during movement, pain management and compliance with pain treatment guidelines in children and adolescents receiving hospital care. Furthermore, to examine self-reported statements about pain relief and how often staff asked about pain.MethodsA quantitative, cross-sectional study with descriptive statistics as the data analysis method was conducted at a county hospital in western Sweden. Sixty-nine children/adolescents aged 6–18 years who had experienced pain during their hospital stay were included. A structured, verbally administered questionnaire was used to obtain pain reports. The participants were also asked what they considered alleviated pain and how often they told staff about pain. Patient demographics, prescribed analgesics and documentation of pain rating were obtained from medical records.ResultsFifty children/adolescents (72%) experienced moderate to severe pain in the previous 24 hours. At the time of the interview 36% reported moderate to severe pain at rest and 58% during movement. Seven participants (10%) reported severe pain both at rest and during movement. About one-third were on a regular multimodal analgesic regimen and 28% had used a validated pain rating scale. Thirty children/adolescents (43%) reported that they had experienced procedural pain in addition to their underlying pain condition. Most of the children/adolescents (74%) reported that analgesics provided pain relief. Forty (58%) stated that various non-pharmacological methods were helpful.ConclusionsDespite evidence-based guidelines, half of the children/adolescents experienced moderate to severe pain, highlighting the need for improvement. Pain levels should be assessed both at rest and during movement. Response to treatment should be evaluated to prevent undertreatment of pain. Compliance with guidelines and professional communication are of the utmost importance for pain management in children/adolescents. Non-pharmacological methods are a valuable part of a pain management strategy. This study shows that it is important to evaluate and improve pain care also outside specialised tertiary clinics.

Hospitalized Children With Limited English Proficiency: The Strive to Improve Analgesia.

Hospitalized Children With Limited English Proficiency: The Strive to Improve Analgesia.

Ultrasound-Guided Comparison of Psoas Compartment Block and Supra-Inguinal Fascia Iliaca Compartment Block for Pain Management in Pediatric Developmental Dysplasia of Hip Surgeries.

BackgroundThe aim of this study was to compare psoas compartment block (PCB) and supra-inguinal fascia iliaca compartment block (SFIB) in terms of pain management and the need for additional systemic analgesia in the perioperative phase of developmental dysplasia of the hip (DDH).Materials and MethodsSixty pediatric patients were randomized into the PCB group and the SFIB group. The Numeric Rating Scale (NRS) pain scores were used to assess postoperative pain during the initial 24 h after extubation. Sufentanil consumption, patient-controlled analgesia (PCA) demands, and complications were also recorded.ResultsThe NRS pain scores were significantly lower in the PCB group than in the SFIB group at 0, 4, 8, 12, and 24 h after extubation (all P < 0.01). Postoperatively, 13.8% of patients in the PCB cohort received additional administration of sufentanil, in contrast to 63.3% of the SFIB cohort (P < 0.01). In the PCB group, 0 (0-0) mcg/kg sufentanil was administered, while in the SFIB group 0.1 (0-0.2) mcg/kg (P < 0.01). In addition, the PCB group had fewer PCA demands than the SFIB group within the initial 24 h (P < 0.01). It took less operating time to achieve SFIB as compared to PCB (P < 0.01). No adverse events related to two techniques were recorded.ConclusionsPCB provided a better perioperative pain management in pediatric patients with the DDH surgeries compared to SFIB. It also reduced the need for supplementary systemic analgesia.

Ambulatory Pain Management in the Pediatric Patient Population.

Outpatient surgery in the pediatric population has become increasingly common. However, many patients still experience moderate to severe postoperative pain. A poor understanding of the extent of pain after pediatric ambulatory surgery and the lack of randomized control studies of pain management of the outpatient necessitate this review of scientific evidence and multimodal analgesia. A multimodal approach to pain management should be applied to the ambulatory setting to decrease postoperative pain. These include non-pharmacological techniques, multimodal pharmacologics, and neuraxial and peripheral nerve blocks. Postoperative pain management in pediatric ambulatory surgical patients remains suboptimal at most centers due to limited evidence-based approach to postoperative pain control. Pediatric ambulatory pain management requires a multipronged approach to address this inadequacy.

What's New in Pain Management for Pediatric Orthopaedic Surgery.

Improving pain control and decreasing opioid prescription and usage continue to be emphasized across both pediatric and adult populations. The purpose of this review is to provide a comprehensive assessment of recent literature and highlight new advancements pertaining to pain control in pediatric orthopaedic surgery. An electronic search of the PubMed database was performed for keywords relating to perioperative pain management of pediatric orthopaedic surgery. Search results were filtered by publication date for articles published between January 1, 2015 and December 1, 2020 and yielded 404 papers. A total of 32 papers were selected for review based upon new findings and significant contributions in the following categories: risk factors for increased opioid usage, opioid overprescribing and disposal, nonpharmacologic interventions, nonsteroidal anti-inflammatory drugs, peripheral nerve blocks, spine surgery specific considerations, surgical pathway modifications, and future directions. There have been many advances in pain management for pediatric patients following orthopaedic surgery. Rapid recovery surgical care pathways are associated with shorter length of stay and improved pain control in pediatric spine surgery. Opioid overprescribing continues to be common and information regarding safe opioid disposal practices should be routinely provided for pediatric patients undergoing surgery. Level IV-literature review.

State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients.

Purpose of ReviewThis review summarizes and provides a comprehensive narrative synthesis of the current evidence on immersive technology’s (i.e., virtual and augmented Reality) use for perioperative anxiety, acute, and chronic pain in pediatrics.Recent FindingsResearchers have increasingly studied immersive technology as a non-pharmacological alternative for perioperative anxiety, acute, and chronic pain management. We found several research studies published over the last 3 years: almost all studies examined the use of virtual reality for perioperative anxiety and pain; only one case report was about the use of augmented reality for preoperative anxiety. Most studies showed that virtual reality intervention is effective and safe for perioperative anxiety, acute, and chronic pain. However, the studies are heterogeneous with relatively small sample sizes.SummaryThis review shows that more high-quality studies (i.e., randomized controlled trials with larger sample sizes and standardized methods for measuring and reporting outcomes) are needed to examine the effectiveness and adverse effects of virtual reality intervention on perioperative anxiety, acute, and chronic pain in pediatrics.

PNS15 Cost-Effectiveness Analysis of Pharmacogenetic Testing in Opioid Analgesia in Pediatric Population Undergoing Surgery

For pediatric patients deemed ultra-rapid metabolizers (UMs), genetic variability in CYP2D6 increases codeine’s risk of respiratory depression and death. As the cost of pharmacogenomics (PGx) testing decreases and the sensitivity and specificity of PGx testing improves, pain management may benefit from greater PGx-testing adoption. The objective of this study is to determine the cost-effectiveness of PGx testing to guide short-term post-surgical codeine therapy in pediatric patients. We developed a TreeAge-based decision analytical model to compare opioid analgesia with and without PGx testing using a payer’s perspective. For PGx-guided opioid analgesia, we restricted the use of codeine to non-UMs only and considered alternative opioids among patients deemed UMs. We measured the effectiveness as (i) reduction in the hospital length of stay (LOS) due to opioid-induced adverse drug reactions (ADRs) related to the respiratory system, and (ii) averting respiratory depression, a severe opioid-induced ADR. Model parameters were taken from published literature. Compared to non-PGx testing, PGx testing resulted in approximately 0.0441 fewer LOS days with an incremental cost of $362, resulting in TreeAge reported incremental cost-effectiveness ratio (ICER) of $8,214. PGx testing also resulted in approximately 0.0055 fewer respiratory depression events with an incremental cost of $404 compared to non-PGx testing. The TreeAge reported ICER value was estimated at $73,177 to avert a severe respiratory depression event with PGx testing. The results were robust in probabilistic sensitivity analyses for LOS outcomes. However, for the respiratory depression outcome, 71.8% of iterations resulted in an ICER value exceeding the common $50,000 willingness to pay threshold. This analysis suggested that PGx guided opioid analgesia with codeine is a cost-effective strategy for pain management in pediatric patients. As the availability and cost of PGx testing improve, policymakers may want to reconsider the benefit of PGx guided pain management, including codeine.

Postoperative Craniotomy Pain Management in Pediatric Patients: A Systematic Review

Chronic pain after stroke is a common, yet often overlooked sequela of cerebrovascular injury. Among the syndromes seen in post-stroke pain (PSP) are central post-stroke pain (CPSP) and complex regional pain syndrome (CRPS). Shoulder pain develops in a large subset of patients with residual upper-extremity weakness. Shoulder pain after stroke is multifactorial. Treatment of pain in these patients can be challenging when the exact etiology is unclear, and may necessitate multiple, successive therapeutic approaches before an effective remedy is found. Here we present a case of Post-Stroke Shoulder Pain of multifactorial etiology in which multiple treatment strategies were utilized, including successful trial of a cervical spinal cord stimulator (SCS) device.