Painful Procedures Research Articles

Effectiveness of Preoperative Alpha Wave Entrainment in Pediatric Dental Patients: A Randomized Controlled Trial.

Background Pediatric dental anxiety is a significant barrier to effective dental care, necessitating non-pharmacological interventions. Alpha wave entrainment has shown promise in adult studies for reducing procedural anxiety and pain perception, but its effectiveness in pediatric dental settings remains underexplored. Objective This study aims to evaluate the effectiveness of preoperative alpha wave entrainment in alleviating anxiety in gender-specific participants to the interventions. Methods We conducted a randomized controlled trial involving 252 pediatric patients (aged 7-12) with cooperative dispositions. Participants were randomly assigned to either an experimental group receiving alpha wave entrainment or a control group receiving conventional behavior management techniques. The experimental interventioninvolved 10-minute sessions of binaural beats with visualstimulation designed to induce alpha-wave synchronization. Anxiety levels were assessed using physiological measures (heart rate and blood pressure), both pre- and post-interventions. Results The intervention group demonstrated a significant reduction in heart rate and systolic blood pressure post-intervention compared to the control group. These changes indicate a decrease in anxiety levels, with no significant gender differences in the response to the intervention. Conclusion Alpha wave entrainment effectively reduces dental anxiety in pediatric patients, with similar efficacy observed across genders. This study supports the incorporation of alpha wave entrainment into pediatric dental practices as a viable alternative to traditional anxiety management techniques.

Anesthesia and Analgesia Recommended for Painful Procedures in Small Animals

The non-invasive but painful and invasive procedures are frequently performed in experimental animal studies, such as blood withdrawal, route of administration, and surgical procedures. Most of these procedures commonly conducted under anesthesia and/or analgesia and should be complied with the ethical requirements. However, pain is difficult to assess in animals, therefore, it is advisable to provide the analgesics pre-emptively or if painful condition is expected. Preanesthetic like tranquilizer is generally used to reduce the stress in animal and further it also aids in the smooth induction of anesthesia and recovery. In view of this, the objective is to demonstrate and discuss the guidelines of anesthesia and analgesia in small animals, especially mouse and rat with principal focus to ethical purview. These guidelines can be applicable to the animal house facility, pharmacology laboratory, and to a large extent for veterinary care.

Sedoanalgesia With Ketamine in the Emergency Department: Factors Associated With Unsatisfactory Effectiveness.

Ketamine is a safe and widely used sedative and analgesic in children. The purpose of this study is to evaluate the response to sedoanalgesia for painful procedures in the pediatric emergency department. A retrospective study was conducted in children younger than 16 years who underwent painful procedures with intravenous/intranasal ketamine between January 2016 and December 2022. We collected demographic variables, effectiveness, route of administration, indication, dose, sedation strategy, duration of procedure, and associated adverse effects. A total of 671 ketamine sedation procedures (411 males/260 females) were included, with a mean age of 7.2 years. Closed reduction was the most common painful procedure (53.8%), followed by burn healing (24.6%). Ketamine was administered intravenously in 93.4% of procedures and intranasally in 6.6%. The result of sedoanalgesia was satisfactory in 84.9% and unsatisfactory in 15.1%. The percentage of cases with unsatisfactory analgesia was higher with intranasal administration (36.4%; P < 0.001). In the intravenous group, the percentage of cases with unsatisfactory effectiveness (28.7%) was higher for patients younger than 2 years of age (P < 0.001). Arthrocentesis procedures were associated with the highest percentage of unsatisfactory sedoanalgesia failures among patients receiving intravenous ketamine (39.3%; P < 0.001). Intranasal ketamine patients who received a dose between 3.6 and 4 mg/kg had a significantly higher percentage of unsatisfactory sedoanalgesia (66.7%; P = 0.048). Patients receiving intravenous ketamine had significantly higher rates of unsatisfactory sedoanalgesia when the initial dose interval was 1.6 to 2 mg/kg (11.8%; P = 0.002) and when the final total dose was also 1.6 to 2 mg/kg (17.6%; P = 0.002). This study concludes that intravenous/intranasal ketamine can provide safe and successful analgesia in pediatric patients in the ED. At intravenous doses of 1-1.5 mg/kg, good effectiveness was achieved in almost 90% of cases. Arthrocentesis had the highest percentage of unsatisfactory results. Repeat dosing should be considered for procedures longer than 20 minutes.

Paediatric laceration repair in the emergency department: post-discharge pain and maladaptive behavioural changes

BackgroundPaediatric laceration repair procedures are common in the ED; however, post-discharge recovery remains understudied. Perioperative research demonstrates that children exhibit maladaptive behavioural changes following stressful and painful medical procedures. This...

PSII-3 Evaluation of a microneedle patch for the delivery of meloxicam in a veterinary application

Abstract In the livestock industry, animals undergo painful procedures such as castration and these practices have received increased scrutiny and concern regarding animal welfare. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to treat pain and inflammation in livestock. Novel administration routes such as transdermal drug delivery using polymeric biodegradable microneedle patches that are being developed to deliver drugs in a less stressful method. Therefore, the objective of this study was to evaluate meloxicam plasma concentrations when drug was delivered using a microneedle patch. Nursing pigs (n = 7; body weight = 3.69 ± 1.12 kg) from 1 litter were stratified into 1 of 3 treatment groups. Treatments were: 1) 0.5 mg of meloxicam/kg of body weight via oral drench (n = 2; oral); 2) a patch devoid of meloxicam (n = 1; placebo); or 3) 2.5 mg of meloxicam/kg of body weight delivered via microneedle patch (n = 4; patch). During the study, pigs remained in the crate with the sow and littermates. Blood was collected via jugular venipuncture for plasma analysis at 0, 8, 24, 48, and 72 h. An Estrotect Breeding Indicator strip was used to adhere the microneedle patch on the ear of the pigs. Briefly, the strip was cut to the size of the ear, a microneedle patch was placed at the center, and these were applied on the pinna of the ear after blood collection at 0 h. Statistical analyses were performed using the MIXED procedure of SAS 9.4 (Cary, NC) to assess the effects of treatment, time, and treatment × time interaction. Statistical significance was determined at P ≤ 0.05, with tendencies at 0.05 &amp;lt; P ≤ 0.1. There was a treatment × time interaction (P = 0.0074), with the pigs that received oral meloxicam having greater meloxicam plasma concentrations at 8 h compared with pigs that received a placebo patch or a patch containing meloxicam (P &amp;lt; 0.0001). There were no differences in plasma meloxicam concentrations between pigs receiving a placebo patch or a patch containing meloxicam (P = 0.9). Plasma levels of meloxicam were detectable but low in pigs that received a microneedle patch (0.91 ng/mL). Research is continuing to determine the ideal microneedle patch polymer and structure that would deliver meloxicam to achieve desired plasma concentrations.

Case Report: Virtual natural environment solution helped a child cope with a painful procedure

Fear of needles is a common phenomenon that can affect the patient's ability to function and to seek medical help. Novel treatment practices are needed to help children cope with this fear. Based on user feedback, immersive virtual reality applications are effective when distracting the patient during a painful procedure. Better understanding of how virtual reality solutions affect the autonomic nervous system should be acquired. We present the case of a 12-year-old boy attending our study examining a novel virtual reality (VR) relaxation method (VirNE). The clinical study aims to determine if pain and anxiety can be relieved by relaxation that has been induced by a virtual natural environment and guided relaxation exercise-mediated autonomic nervous system stimulation. The patient was able to overcome his fear of needles with the help of the guided relaxation and found significant relief from the distress he was experiencing on his monthly visits to the hospital due to his long-term illness requiring repetitious intravenous cannulations.

The downside to choice: instrumental control increases conditioned nocebo hyperalgesia.

Nocebo hyperalgesia is a pervasive problem in which the treatment context triggers negative expectations that exacerbate pain. Thus, developing ethical strategies to mitigate nocebo hyperalgesia is crucial. Emerging research suggests that choice has the capacity to reduce nocebo side effects, but choice effects on nocebo hyperalgesia have not been explored. This study investigated the impact of choice on conditioned nocebo hyperalgesia using a well-established electrocutaneous pain paradigm where increases in noxious stimulation were surreptitiously paired with the activation of a sham device. In study 1, healthy volunteers (N = 104) were randomised to choice over (nocebo) treatment administration, nocebo administration without choice, or a natural history control group. Nocebo hyperalgesia was greater for those with choice than no choice, suggesting that choice increased rather than diminished nocebo hyperalgesia. Study 2 tested whether providing positive information about the benefits of choice in coping with pain could counteract heightened nocebo hyperalgesia caused by choice. A different sample of healthy adults (N = 137) were randomised to receive nocebo treatment with choice and positive choice information, choice only, or no choice. The positive choice information failed to attenuate the effect of choice on nocebo hyperalgesia. The current results suggest that, rather than decreasing nocebo hyperalgesia, treatment choice may exacerbate pain outcomes when a painful procedure is repeatedly administered. As such, using choice as a strategy to mitigate nocebo outcomes should be treated with caution.

Avoiding pain during propofol injection in pediatric anesthesia: Hypnoanalgesia of the hand versus intravenous lidocaine.

Pain related to injection of propofol during induction of anesthesia decreases from 66.8% without prevention, to 22-31% of cases when lidocaine is associated. Hypnoanalgesia of the hand is currently used for painful procedures in children but has never been evaluated in this indication. The primary aim of this prospective randomized single-blind study was to evaluate the efficacy of hypnoanalgesia of the hand for the prevention of moderate to severe pain during intravenous injection of propofol alone in comparison to lidocaine admixture. The secondary aim was to compare the global satisfaction of children in both methods. One hundred patients aged 7-14 years, ASA 1-2, admitted for scheduled surgery under general anesthesia were randomized into two groups. Group L received a mixture of 1% propofol (3 mg/kg) and 1% Lidocaine (0.3 mg/kg). Group H received 1% propofol (3 mg/kg) after hypnoanalgesia of the hand realized by a single experimented operator. A video was made in order to evaluate the pain related to propofol injection by a blinded observer using the 4-point score of Cameron (painful ≥ 2). The global satisfaction of children was evaluated in postanesthesia care unit and documented if visual analog score was <7/10. Ninety-six patients were analyzed. The rate of painful patients did not differ significantly between groups (8.5% in group H [n = 47] vs 6.1% in group L [n = 49], OR= 0.70; 95% CI [0.13-3.35], p = 0.65), nor did the rate of nonsatisfied patients (10.6 in group H vs. 12.2% in group L, OR = 0.85; 95% CI [0.19-3.65], p = 1). Our results suggest that hypnoanalgesia of the hand alone is effective to prevent the pain related to propofol injection in children. No significant difference was found in comparison with lidocaine admixture nor for pain or satisfaction.

Procedural sedation by advanced practice providers in the emergency medical service in the Netherlands: a retrospective study.

Procedural sedation and analgesia (PSA) is a technique of administering sedatives to induce a state that allows the patient to tolerate painful procedures while maintaining cardiorespiratory function, a condition that is frequently desired prehospital. Non-physician prehospital clinicians often have a limited scope of practice when it comes to providing analgesia and sedation; sometimes resulting in a crew request for back-up from physician-staffed prehospital services.". This is also the case if sedation is desirable. Advanced practice providers (APPs), who are legally authorized and trained to carry out this procedure, may be a solution when the physician-staffed service is not available or will not be available in time. The aim of this study is to gain insight in the circumstances in which an APP, working at the Dutch ambulance service "RAV Brabant MWN" from January 2019 to December 2022, uses propofol for PSA or to provide sedation. With this a retrospective observational document study we describe the characteristics of patients and ambulance runs and evaluates the interventions in terms of safety. During the study period, the APPs administered propofol 157 times for 135 PSA and in 22 cases for providing sedation. The most common indication was musculoskeletal trauma such as fracture care or the reduction of joint dislocation. In 91% of the situations where propofol was used, the predetermined goal e.g. alignment of fractured extremity, repositioning of luxated joint or providing sedation the goal was achieved. There were 12 cases in which one or more adverse events were documented and all were successfully resolved by the APP. There were no cases of laryngospam, airway obstruction, nor anaphylaxis. None of the adverse events led to unexpected hospitalization or death. During the study period, the APPs performed 135 PSAs and provided 22 sedations. The success rate of predetermined goals was higher than that stated in the literature. Although there were a number of side effects, their incidences were lower than those reported in the literature, and these were resolved by the APP during the episode of care. Applying a PSA by an APP at the EMS "RAV Brabant MWN" appears to be safe with a high success rate.

Multimodal monitoring using the Analgesia Nociception Index (ANI) during catheter ablation of the heart in patients with sinus rhythm and short-term induced atrial arrhythmia: prospective observational study

INTRODUCTION: Сatheter ablation (CA) is a painful procedure requiring an assessment of the balance between nociception associated with surgical trauma and anesthesia induced antinociception. OBJECTIVE: To evaluate the effectiveness of the monitoring system “ANI Monitor” for anesthesia and intensive care in patients with sinus rhythm and short-term induced (&lt; 1 min) atrial arrhythmia (STIAA). MATERIALS AND METHODS: The study group of our trial consisted of 94 patients with CA and ANI Monitor. The control group consisted of 94 patients, selected using the “copy-pair” method, with standard (hemodynamic) monitoring. A Numerical Rating Scale (NRS) was used for assessment the intensity of pain. At the stage of femoral vein catheterization in all patients regional anesthesia was performed, at the CA stage, procedural sedation and/or analgesia (PSA) was titrated with the administration of propofol and fentanyl (under the control with ANI Monitor). Statistical data processing was carried out using Statistica 10.0 and SPSS programs. RESULTS: At the stage of CA under PSA, negative correlation was found between NRS and ANIm in patients with sinus rhythm and STIAA (r = −0.37). At the threshold of 56.0 the sensitivity and specificity of ANIm in detecting NRS ˃ 3 were 60 and 100 %, respectively, corresponding to ROC curve AUC of 0.81. Significant changes in hemodynamic reactivity were not registered. It was revealed the reduction of fentanyl administration in patients of the study group (0.04 ± 0.02 and 0.05 ± 0.03 µg/kg/min, respectively, p &lt; 0.001) under the control of ANI Monitor. CONCLUSIONS: ANI Monitor during CA in patients with sinus rhythm and STIAA was more effective in detecting harmful nociceptive stimuli compared to standard (hemodynamic) monitoring. The use of ANI Monitor to control the fentanyl administration could create conditions for opioid-sparing anesthesia.

Safety and Effectiveness of Percutaneous Ultrasound-Guided Galvanic Current in Tunnels of Patients with Hidradenitis Suppurativa: A Pilot Study.

The recurrent nature of hidradenitis suppurativa (HS), even under maintained systemic treatment, makes it necessary to have effective local treatments; however, the response to these therapies is variable (44-81%). The application of galvanic current (GC) has demonstrated its utility in humans in treating lesions structurally similar to those of HS. With this background, the main objective of this study was to evaluate the efficacy and safety of ultrasound-guided percutaneous GC in inflamed and/or draining tunnels of HS. This was an open study (one-way repeated measures design over time). Patients were evaluated at 4 and 12weeks after receiving GC. A combined clinical response at week12 (absence of suppuration/inflammation on examination and clinical interview) was considered the principal variable of efficacy. Adverse effects potentially associated with GC were reported by telephone and at each visit. Twenty-six patients were included, with a male/female ratio of 5:8. The mean age was 35.84 (13.14) years. At 12weeks after the administration of GC, a complete response was achieved in 77% (20/26) of the treated lesions. No serious adverse effects were observed, and the mean procedural pain assessed by the numeric rating scale was 0.03 (0.2). GC has proven to be effective and well tolerated in inflamed and draining tunnels of patients with HS.

Procedural Sedation in Emergency Department: A Narrative Review

Procedural sedation and analgesia (PSA) in the emergency department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. The results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. The conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and the adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.

P068 The Use of Virtual Reality Headsets instead of Entonox for Paediatric Patients undergoing Steroid Joint Injections or Venepuncture / Cannulation

Abstract Background/Aims Entonox has traditionally been used for patients with Juvenile idiopathic arthritis (JIA) who require intra-articular joint injections (IAIs). However, Entonox is now the third most misused drug especially in school age children and young people (CYP). Entonox also has an environmental impact. In addition, Entonox has side-effects including euphoria, disorientation, nausea and vomiting. Recently there has been increased awareness of the risks of Vitamin B deficiency associated with prolonged Entonox use which can lead to neurological toxicity. These factors have led us to consider virtual reality (VR) devices as an alternative for patients requiring IAIs. The VR headset we used is a class one medical device that can provide both reduction in anxiety levels and pain relief in patients needing anxiety-provoking or painful procedures such as IAIs. Aims: To trial the use of VR devices in a Paediatric Rheumatology Service and to assess effectiveness in reducing anxiety and pain when used during IAIs and cannulation / venepuncture. Methods A pragmatic pilot study of VR headset use was carried out from November 2022 until September 2023. All CYP undergoing IAIs without GA were offered either Entonox sedation or VR headset distraction. Each CYP using the VR headset was asked to score anxiety and pain levels before and after the procedure using a Likert scale. Patient demographics were also collected (age and gender). Results A total of 42 patients attended for IAI’s during the study window between the ages of 7 and 16. Thirty-three opted to use the VR headset. Nine opted for Entonox. An additional 22 patients opted to use the VR headset for venepuncture / cannulation. The 64 users of the VR headset reported an average 47.8% reduction in anxiety and a 0.8% reduction in pain. Conclusion The study demonstrated that the use of a VR headset reduces anxiety in CYP having painful procedures. A minimal reduction in pain however was reported. This may be due to some patients having low pre procedural pain scores. The terms of the headset loan limited the questions that could be set for data collection. It has therefore not been possible to separate results from children who underwent IAIs or venepuncture / cannulation. We also did not collect comparative scores from the Children and young people who chose to use Entonox. Funding has now been secured for the VR headset and we are carrying out a prospective evaluation, including feedback from patients and staff, into the role of VR devices in managing situations involving procedural anxiety. Disclosure H.C. Lee: None. S. Leach: None. D. Hawley: None. N. Barker: None.

Description of postoperative complications and bacterial contamination of wound soaker catheters used to administer postoperative local analgesia after mastectomy in 11 dogs: case series.

Mastectomy is a common and painful procedure in dogs. Wound soaker catheters (WSC) are frequently used to reduce postoperative pain, including pain after mastectomy. The objectives of this case series were to describe the use of WSC for owner administration of postoperative local analgesia in dogs with mammary tumors treated surgically, to identify complications associated with WSC and to determine the frequency of bacterial colonization of the catheters. Twelve WSC were placed in 11 dogs during mastectomy surgery, left in place for three days, protected by a dressing and successfully managed by owners at home. No postoperative antibiotics were administered. No complications were identified in any cases. No bacterial growth was identified on bacteriological analysis of the twelve WSC. These results suggest that the use of WSC is a safe alternative for postoperative analgesia administration following mastectomy in dogs. Future studies comparing dogs with or without WSC with a larger number of dogs are needed to further evaluate efficacy and complications.

The Impact of Music Perception on Quantitative Sensory Testing (QST).

Objective: The impact of listening to music on pain perception has been evaluated using questionnaires and numeric/visual analogue scales. In this study, the impact of music perception on sensory pain functions was measured by means of quantitative sensory testing. Methods: We enrolled 10 female and 10 male healthy subjects (10 of them were professional musicians). All subjects underwent, in total, four quantitative sensory testing measures (first: baseline; second: after pleasant music [Johannes Brahms, 3rd symphony, 3rd movement]; third: after unpleasant music [Krzysztof Penderecki, Threnos]; fourth: after a longer break). The pleasantness of music was evaluated using the Ertel differential scale. Results: After the participants listened to pleasant music, an increased sensitivity to cold stimuli (both threshold and pain), to mechanical stimuli (only for threshold), and to repeated stimuli (wind-up reaction) was noted. Listening to unpleasant music was not associated with changes in sensitivity. We did not observe any significant differences between male and female subjects or between musicians and non-musicians. There was no significant correlation between the rating of the music as pleasant/unpleasant and the different quantitative sensory testing measures. Conclusions: Our data show that listening to music inducing a pleasant feeling can increase the sensitivity to stimuli applied during a quantitative sensory testing session. This should be considered when performing or interpreting quantitative sensory testing examinations. Interestingly, this finding is in contrast to the observation that listening to music can decrease pain perception during painful procedures.

29 Virtual Reality to Reduce Patients’ Procedural Pain and Anxiety

29 Virtual Reality to Reduce Patients’ Procedural Pain and Anxiety

Parent-led neonatal pain management-a narrative review and update of research and practices.

Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills. In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research. Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change. Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.

The effect of maternal voice and non-nutritional sucking on repeated procedural pain of heel prick in neonates: a quasi-experimental study

BackgroundNeonates in the neonatal intensive care unit undergo frequent painful procedures. It is essential to reduce pain using safe and feasible methods.PurposeTo evaluate the effects of non-nutritional sucking, mother’s voice, or non-nutritional sucking combined with mother’s voice on repeated procedural pain in hospitalized neonates.MethodsA quasi-experimental study was conducted in which 141 neonates were selected in a hospital in Changsha, China. Newborns were divided into four groups: non-nutritional sucking (NNS) (n = 35), maternal voice (MV) (n = 35), NNS + MV (n = 34), and control (n = 37) groups. The Preterm Infant Pain Profile-Revised Scale (PIPP-R) was used to assess pain.ResultsDuring the heel prick, the heart rate value and blood oxygen saturation were significantly different between the groups (P < 0.05). Both non-nutritional sucking and maternal voice significantly reduced PIPP-R pain scores of hospitalized newborns (P < 0.05). The pain-relief effect was more robust in the combined group than in other groups.ConclusionsThis study showed that both non-nutritional sucking and the mother’s voice alleviated repeated procedural pain in neonates. Therefore, these interventions can be used as alternatives to reduce repeated procedural pain.

Effectiveness of Intravenous Low-Dose Ketamine Versus Morphine for Procedural Burn Pain Management During Dressing Changes: A Randomized Clinical Trial

Background: There is limited literature on using low-dose intravenous ketamine as a single agent for procedural burn pain management during adult dressing changes. Aims &amp; Objectives: To determine the effectiveness of low-dose ketamine compared to morphine as a single analgesic agent in procedural burn pain management during dressing changes. Materials &amp; Methods: We performed an institutional review board-approved, randomized, prospective, double-blinded, controlled, non-inferiority trial. All adult patients 18 years and above scheduled for dressing change were screened. Patients who consented were randomized to receive low-dose ketamine infusion at 0.2mg/kg/hr. In the treatment group, morphine infusion at 0.1mg/kg/hr. In the control group. The primary endpoint was pain intensity, measured using a visual analog scale. Data were analyzed on an intention-to-treat (ITT) approach. Secondary endpoints included rescue analgesia requirements and the occurrence of adverse effects in both groups. Results: 82 patients were enrolled (ketamine 41 vs. morphine 41). We compared VAS scores at 5-minute intervals during the dressing changes. Overall, pain scores are similar in both groups (p-value=0.595). The pain control was homogenous. However, the morphine group required more rescue analgesia throughout the dressing changes than the low-dose ketamine group (p=0.013 at T15, p&lt;0.001 at T20, and p&lt;0.001 at T30). The occurrence of side effects was similar in both groups. Conclusion: This study suggests that low-dose ketamine provides as effective and more predictable procedural analgesia as morphine during dressing procedures for adult burn patients.

Urinary markers of pain in children in neonatal intensive care units: a cross-section study

Introduction: Repetitive exposition to pain negatively affects newborns development. Procedural pain in newborn in Neonatal Intensive Care Unit (NICU) triggers a series of physiological, behavioral and hormonal disorders that may set off the impairment of the neurological development in preterm infants, who undergo long periods of hospitalization at a moment of physiological immaturity and fast brain development. Objective: This study aimed not only to observe the pain score in newborns and infants when undergoing painful procedures in neonatal intensive care units but also to analyse urinary IL-8 and cortisol levels at such stressful moments. Methods: Patients were submitted to venipuncture and to other methods of blood collection. Cortisol and IL-8 levels were measured by immunometric assay and chemiluminescence detection. For the collection of data regarding observation of neonatal pain, the Neonatal Infant Pain Scale was used with immediate results. To describe the qualitative variables, absolute and relative frequencies were used. For the quantitative variables with normal distribution, mean, standard deviation, minimum and maximum were used. Results: A total of 81 patients were included: 47 were submitted to venipuncture and 36 to other methods of blood collection. Significance for cortisol can be seen (p=0.04); however, IL-8 levels, when associated with the pain scale, were not sensitive enough (p=0.11). Conclusion: The results showed that cortisol is a better marker for pain than IL-8, and its accumulation in urine may help the detection and interpretation of pain. Conclusion: Based on this information, nurses can step in to reduce the discomfort brought by painful procedures, and thus highlight humanistic practices in nursing assistance.