Postoperative Pain In Children Research Articles

The influence of COMT and ABCB1 gene polymorphisms on sufentanil analgesic effect for postoperative pain in children with fracture.

The aim of this observational study was to investigate the effects of catechol-O-methyltransferase (COMT) and ATP-binding cassette transporter B1 (ABCB1) gene polymorphisms on the postoperative analgesic effect of sufentanil in Chinese Han pediatric patients with fractures. A total of 185 pediatric patients who underwent fracture surgery were included. Polymerase chain reaction-restriction fragment length polymorphism was used to detect the polymorphisms of COMT and ABCB1 genes. Sufentanil was used for postoperative analgesia. The pain level of the patients was evaluated using the face, legs, activity, cry, and consolability scale before surgery, during awakening, at 2, 6, 12, and 24 hours after surgery. The postoperative Ramsay sedation score, sufentanil consumption, and incidence of adverse reactions were also recorded. Pediatric patients with different genotypes of ABCB1 and COMT showed no statistically significant differences in general data such as age, gender, weight, height, surgical duration, and American Society of Anesthesiologists classification (P > .05). There were no statistically significant differences in sedation scores after surgery between different genotypes of ABCB1 and COMT (P > .05). Among patients with CC genotype in ABCB1, the pain scores and total consumption of sufentanil at awakening, 2 and 6 hours after surgery were higher compared to TT and CT genotypes (P < .05), while there were no statistically significant differences between TT and CT genotypes (P > .05). Among patients with AA genotype in COMT, the pain scores and total consumption of sufentanil at awakening, 2, 6, 12, and 24 hours after surgery were higher compared to AG and GG genotypes (P < .05), while there were no statistically significant differences between AG and GG genotypes (P > .05). There were no statistically significant differences in adverse reactions between different genotypes of ABCB1 and COMT (P > .05). The polymorphisms of COMT gene rs4680 and ABCB1 gene rs1045642 are associated with the analgesic effect and consumption of sufentanil in pediatric patients after fracture surgery.

Efficacy of different routes of acetaminophen administration for postoperative pain in children: a systematic review and network meta-analysis.

Acetaminophen is the most common drug used to treat acute pain in the pediatric population, given its wide safety margin, low cost, and multiple routes for administration. We sought to determine the most efficacious route of acetaminophen administration for postoperative acute pain relief in the pediatric surgical population. We conducted a systematic review of randomized controlled trials (RCTs) that included children aged between 30days and 17yr who underwent any type of surgical procedure and that evaluated the analgesic efficacy of different routes of administration of acetaminophen for the treatment of postoperative pain. We searched MEDLINE, CENTRAL, Embase, CINAHL, LILACs, and Google Scholar databases for trials published from inception to 16 April 2023. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias 1.0 tool. We performed a frequentist network meta-analysis using a random-effects model. Our primary outcome was postoperative pain using validated pain scales. We screened 2,344 studies and included 14 trials with 829 participants in the analysis. We conducted a network meta-analysis for the period from zero to two hours, including six trials with 496 participants. There was no evidence of differences between intravenous vs rectal routes of administration of acetaminophen (difference in means, -0.28; 95% confidence interval [CI], -0.62 to 0.06; very low certainty of the evidence) and intravenous vs oral acetaminophen (difference in means, -0.60; 95% CI, -1.20 to 0.01; low certainty of the evidence). For the comparison of oral vs rectal routes, we found evidence favouring the oral route (difference in means, -0.88; 95% CI, -1.44 to -0.31; low certainty of the evidence). Few trials reported secondary outcomes of interest; when comparing the oral and rectal routes in the incidence of nausea and vomiting, there was no evidence of differences (relative risk, 1.20; 95% CI, 0.81 to 1.78). The available evidence on the effect of the administration route of acetaminophen on postoperative pain in children is very uncertain. The outcomes of postoperative pain control and postoperative vomiting may differ very little between the oral and rectal route. Better designed and executed RCTs are required to address this important clinical question. PROSPERO (CRD42021286495); first submitted 19 November 2021.

Study of caudal ropivacaine with or without dexmedetomidine for postoperative analgesia in paediatric genitourinary infraumbilical surgery: a double-blinded randomized controlled trial.

Various studies have described the use of Dexmedetomidine with local anaesthetic drugs in caudal blocks for the management of postoperative pain in children. This study was designed to determine the analgesic effect of caudal Dexmedetomidine with Ropivacaine in paediatric genitourinary infraumbilical surgeries. Postoperative analgesic effects of caudal Ropivacaine with or without Dexmedetomidine in paediatric genitourinary infraumbilical were evaluated. This study was a prospective, interventional, comparative study conducted after ethical approval from the institute. Informed expressed consent was taken from each patient's guardians. The sample size was calculated to be 31 in each group. The two groups were randomly assigned and the intervention involved caudal epidural injection with either Ropivacaine combined with Dexmedetomidine or Ropivacaine with Normal Saline. Children receiving Ropivacaine with Dexmedetomidine had a significantly prolonged duration of analgesia compared to those receiving Ropivacaine alone (840.35 ± 149.97 vs. 412.90 ± 93.46 min, P < 0.001). Postoperative rFLACC scores were consistently lower in the Dexmedetomidine group, indicating better pain control (P < 0.05 at 6, 12, and 24 h). Total analgesic consumption was lower in the Dexmedetomidine group (500.67 ± 212.92 vs. 741.75 ± 268.06mg, P < 0.01). No significant differences in adverse effects were observed between the groups. The addition of Dexmedetomidine to Ropivacaine in caudal epidural significantly prolongs analgesia, improves pain control, and reduces analgesic consumption in paediatric genitourinary infraumbilical surgeries.

Different Analgesia Techniques for Postoperative Pain in Children Undergoing Abdominal Surgery for Intractable Constipation: A Retrospective Cohort Study in a Single Tertiary Children's Hospital.

Functional constipation in the pediatric population is a prevalent issue that is usually well managed. However, in rare cases, conservative treatment fails, and surgical intervention is necessary. This retrospective cohort study aimed to describe and compare different perioperative analgesic techniques in children undergoing major abdominal surgery for intractable constipation. Conducted between 2011 and 2021, this study enrolled patients under 18 years old who underwent initial major abdominal surgery for intractable constipation (i.e., creation of ostomy or subtotal colectomy). Patients were categorized according to the perioperative analgesic technique (i.e., systemic, neuraxial, or truncal block). Of 65 patients, 46 (70.8%) were female, and the median age was 13.5 [8.8-16.1] years during initial major abdominal surgery. Systemic analgesia was used in 43 (66.2%), neuraxial in 17 (26.2%), and truncal blocks in 5 (7.7%) of the surgeries. Patients with neuraxial analgesia reported less postoperative pain (median [interquartile range] numeric rating scale (NRS) 2.0 [0-4.0]), compared to systemic analgesia (5.0 [2.0-7.0], p < 0.001) and to truncal blocks (5.0 [3.0-6.5], p < 0.001). In this preliminary investigation, neuraxial analgesia appears to be the most effective approach to reducing acute postoperative pain in pediatric patients undergoing major abdominal surgery for intractable functional constipation. However, well-designed studies are warranted.

Ibuprofen for acute postoperative pain in children.

Children often require pain management following surgery to avoid suffering. Effective pain management has consequences for healing time and quality of life. Ibuprofen, a frequently used non-steroidal anti-inflammatory drug (NSAID) administered to children, is used to treat pain and inflammation in the postoperative period. 1) To assess the efficacy and safety of ibuprofen (any dose) for acute postoperative pain management in children compared with placebo or other active comparators. 2) To compare ibuprofen administered at different doses, routes (e.g. oral, intravenous, etc.), or strategies (e.g. as needed versus as scheduled). We used standard Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, CINAHL and trials registries in August 2023. We included randomised controlled trials (RCTs) in children aged 17 years and younger, treated for acute postoperative or postprocedural pain, that compared ibuprofen to placebo or any active comparator. We included RCTs that compared different administration routes, doses of ibuprofen and schedules. We adhered to standard Cochrane methods for data collection and analysis. Our primary outcomes were pain relief reported by the child, pain intensity reported by the child, adverse events, and serious adverse events. We present results using risk ratios (RR) and standardised mean differences (SMD), with the associated confidence intervals (CI). We used GRADE to assess the certainty of the evidence. We included 43 RCTs that enroled 4265 children (3935 children included in this review). We rated the overall risk of bias at the study level as high or unclear for 37 studies that had one or several unclear or high risk of bias judgements across the domains. We judged six studies as having a low risk of bias across all domains. Ibuprofen versus placebo (35 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen probably reduces child-reported pain intensity less than two hours postintervention compared to placebo (SMD -1.12, 95% CI -1.39 to -0.86; 3 studies, 259 children; moderate-certainty evidence). Ibuprofen may reduce child-reported pain intensity, two hours to less than 24 hours postintervention (SMD -1.01, 95% CI -1.24 to -0.78; 5 studies, 345 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events compared to placebo (RR 0.79, 95% CI 0.51 to 1.23; 5 studies, 384 children; low-certainty evidence). Ibuprofen versus paracetamol (21 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen likely reduces child-reported pain intensity less than two hours postintervention compared to paracetamol (SMD -0.42, 95% CI -0.82 to -0.02; 2 studies, 100 children; moderate-certainty evidence). Ibuprofen may slightly reduce child-reported pain intensity two hours to 24 hours postintervention (SMD -0.21, 95% CI -0.40 to -0.02; 6 studies, 422 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events (0 events in each group; 1 study, 44 children; low-certainty evidence). Ibuprofen versus morphine (1 RCT) No studies reported pain relief or pain intensity reported by the child or a third party, or serious adverse events. Ibuprofen likely results in a reduction in adverse events compared to morphine (RR 0.58, 95% CI 0.40 to 0.83; risk difference (RD) -0.25, 95% CI -0.40 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 4; 1 study, 154 children; moderate-certainty evidence). Ibuprofen versus ketorolac (1 RCT) No studies reported pain relief or pain intensity reported by the child, or serious adverse events. Ibuprofen may result in a reduction in adverse events compared to ketorolac (RR 0.51, 95% CI 0.27 to 0.96; RD -0.29, 95% CI -0.53 to -0.04; NNTB 4; 1 study, 59 children; low-certainty evidence). Despite identifying 43 RCTs, we remain uncertain about the effect of ibuprofen compared to placebo or active comparators for some critical outcomes and in the comparisons between different doses, schedules and routes for ibuprofen administration. This is largely due to poor reporting on important outcomes such as serious adverse events, and poor study conduct or reporting that reduced our confidence in the results, along with small underpowered studies. Compared to placebo, ibuprofen likely results in pain reduction less than two hours postintervention, however, the efficacy might be lower at two hours to 24 hours. Compared to paracetamol, ibuprofen likely results in pain reduction up to 24 hours postintervention. We could not explore if there was a different effect in different kinds of surgeries or procedures. Ibuprofen likely results in a reduction in adverse events compared to morphine, and in little to no difference in bleeding when compared to paracetamol. We remain mostly uncertain about the safety of ibuprofen compared to other drugs.

Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study.

Worldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique. The primary outcome was the assessment of the time from the end of surgery and the discharge to the post-anesthesia care unit. Secondary outcomes were to evaluate the cumulative dosages of opioids, differences in pain levels between the two groups, and complications at the awakening, 4 h and 72 h after surgery, respectively. This was a prospective study with a retrospective control group, approved by the Friuli-Venezia Giulia Ethics Committee. Children in the intervention group received an ultrasound-guided DPNB under sedation and spontaneous breathing. With the probe positioned transversally at the base of the penis using an in-plane approach with a modified technique, local anesthetic was injected under the deep fascia of the penis. We recruited 70 children who underwent circumcision at the University Hospital of Udine, Italy, from 1 January 2016 to 1 October 2021: 35 children in the ultrasound-guided DPNB group and 35 children in the control group. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room, did not require mechanical ventilation, maintained spontaneous breathing at all times, received fewer opioids, had lower mean intraoperative arterial pressures, and lower pain levels immediately after surgery. Ultrasound-guided DPNB associated with sedation and spontaneous breathing is a time-saving, opioid-sparing, safe, and effective strategy for the management of intraoperative and postoperative pain in children undergoing circumcision.Clinical trial registration: ClinicalTrial.gov (NCT04475458, 17 July 2020).

CLINICAL AND LABORATORY CHANGES IN POSTSURGICAL PAIN MARKERS IN CHILDREN

Pos toperative pain in children remains a signifi cant problem in pediatric intensive care, possibly related to an imperfectalgorithm for its management. Prolonged postoperative pain delays recovery and rehabilitation, increases treatment costs,and prolongs opioid use. Inadequate perioperative pain management can lead to a variety of postoperative complications, the prediction of which remains elusive despite the use of commonly accepted clinical, laboratory, and instrumental indicators. The aim of this study was to evaluate clinical and laboratory changes in children after abdominal surgery and their correlation with acute pain scales.Material and Methods. The study included 83 children aged 7-18 years who underwent abdominal surgery under opioid anesthesia. Inclusion criteria: age 7-18 years; indication for surgery for acute appendicitis; American Society of Anesthesiologists (ASA) Anesthesia Risk Score I and II; parental consent for the children to participate in the study.Acute pain intensity was measured using the Visual Analog Scale (VAS) and the Face, Legs, Activity, Cry, Consolability(FLACC) scale. Key vital signs assessed included heart rate, respiratory rate, systolic and diastolic blood pressure, and oxygen saturation (SpO2). In addition, laboratory indicators including leukocyte count, blood glucose level, erythrocyte sedimentation rate, and TLR-4 and CD40L levels were determined. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki«Ethical Principles for Medical Research Involving Human Subjects» (Minutes of the Ethics Committee No. 2, dated February 24, 2002). Statistical analysis was performed on a personal computer using Statistica 10 software, using parametric and nonparametric statistical methods. The study is a part of the research project of the Department of Children’s Diseases of the Postgraduate Medical Education Faculty of the Ivano- Frankivsk National Medical University «Health Status and Adaptation of Children from the Precarpathian Region with Somatic Diseases, Their Prevention» 2021-2026, state registration number 0121U111129; the author is a co-researcher.Results. The mean age of the children was 13.8±0.23 years, while the mean body weight was 40.9±1.6 kg. Gender assessment showed no diff erences between boys and girls (55.4 % and 44.6 %, respectively, р&gt;0.05).The study showed very strong positive correlations (r=0.9-1.0) between acute pain assessment scores on the VAS and FLACCscale and heart rate, blood glucose levels; strong positive correlations (r=0.7-0. 9) with total leukocyte count and erythrocytesedimentation rate; moderate positive correlations (r=0.5-0.7) with serum TLR4 and CD40L levels; weak positive correlations(r&lt;0.5) with diastolic blood pressure, SpO2, and opioid and non-opioid analgesic administration.Conclusions. The observed positive correlations between acute pain scores on the VAS and FLACC scale and proinflammatory indicators may support the theory of involvement of these markers in the generation of acute pain in pediatricpatients. However, further research is needed to investigate the mechanisms of acute postoperative pain generation, to identify markers related to nociception in chronic pain, and to develop preventive strategies for these conditions in children.

A comparative study of preoperative ultrasound-guided lumbar erector spine plane block and preoperative ultrasound-guided caudal block for postoperative pain control in pediatric lower limb surgeries: A randomized controlled trial

ABSTRACT Background Erector spinae plane block (ESPB) is a relatively new type of regional anesthesia that has demonstrated efficacy in pain management. The study uses ultrasound (US) guidance to perform the ESPB and evaluates its efficacy and safety compared to the traditional caudal block (CB) in managing postoperative pain in children undergoing lower limb surgeries. Methods This randomized controlled double-blind trial enrolled 50 pediatric cases aged 2–15 years planned for lower limb surgeries. Cases were classified into two equal groups that were administered 0.25% bupivacaine (0.5 ml/Kg) via CB (group C) or lumbar ESPB at the side of operation (group E). The blocks were US guided after induction of anesthesia before skin incision. Results Heart rate and mean arterial pressure at 45, 60, and 75 min, and at the end of surgery were reduced in group C contrasted to group E (P < 0.05). Pain scores at 6 h and 8 h were reduced significantly in group E (P < 0.001 and 0.049 respectively). The time of block performance was significantly lower in group C compared to group E. The number of patients who required intraoperative fentanyl was comparable between groups. Group E had prolonged analgesia and less postoperative pethidine doses. Neither group exhibited local anesthetic toxicity or hematoma with lower incidence of postoperative nausea and vomiting (PONV) in Group E (P = 0.042). Conclusion In pediatric cases undergoing lower limb surgeries, US-guided ESPB provided adequate analgesia (better pain score and prolonged analgesia with lower postoperative analgesic doses) with stable hemodynamic and lower incidence of PONV.

Artificial intelligence in anesthesiology

Artificial intelligence (AI) is rapidly evolving and gaining attention in the medical world. Our aim is to provide readers with insights into this quickly changing medical landscape and the role of clinicians in the middle of this popular technology. In this review, our aim is to explain some of the increasingly frequently used AI terminology explicitly for physicians. Next, we give a summation, an overview of currently existing applications, future possibilities for AI in the medical field of anesthesiology and thoroughly highlight possible problems that could arise from implementing this technology in daily practice. Therefore, we conducted a literature search, including all types of articles published between the first of January 2010 and the 1st of May 2023, written in English, and having a free full text available. We searched Pubmed, Medline, and Embase using “artificial intelligence”, “machine learning”, “deep learning”, “neural networks” and “anesthesiology” as MESH terms. To structure these findings, we divided the results into five categories: preoperatively, perioperatively, postoperatively, AI in the intensive care unit and finally, AI used for teaching purposes. In the first category, we found AI applications for airway assessment, risk prediction, and logistic support. Secondly, we made a summation of AI applications used during the operation. AI can predict hypotensive events, delivering automated anesthesia, reducing false alarms, and aiding in the analysis of ultrasound anatomy in locoregional anesthesia and echocardiography. Thirdly, namely postoperatively, AI can be applied in predicting acute kidney injury, pulmonary complications, postoperative cognitive dysfunction and can help to diagnose postoperative pain in children. At the intensive care unit, AI tools discriminate acute respiratory distress syndrome (ARDS) from pulmonary oedema in pleural ultrasound, predict mortality and sepsis more accurately, and predict survival rates in severe Coronavirus-19 (COVID-19). Finally, AI has been described in training residents in spinal ultrasound, simulation, and plexus block anatomy. Several concerns must be addressed regarding the use of AI. Firstly, this software does not explain its decision process (i.e., the ‘black box problem’). Secondly, to develop AI models and decision support systems, we need big and accurate datasets, unfortunately with potential unknown bias. Thirdly, we need an ethical and legal framework before implementing this technology. At the end of this paper, we discuss whether this technology will be able to replace the clinician one day. This paper adds value to already existing literature because it not only offers a summation of existing literature on AI applications in anesthesiology but also gives clear definitions of AI itself and critically assesses implementation of this technology.

Nalbuphin as an Adjuvant to Levobupivacaine in Caudal Analgesia in Children

Abstract Background Caudal anethesia is the single most important pediatric regional anethetic technique and is increasingly performed in pediatric regional anesthesia practices. It is preferred in order to relieve intraoperative and postoperative pain in children of all age groups undergoing pelvi-abdominal or lower limbs surgeries using levobupivacaine 0.25%.Various adjuvant have been added to levobupivacaine to prolong postoperative caudal analgesia. Nalbuphine as many opioids can be added in caudal analgesia. This prospective randomised double blind study was done to compare the effects of plain levobupivacaine 0.25% versus Levobupivacaine 0.25% plus nalbuphine 0.1 mg/kg single-shot for postoperative pain relief in children undergoing hypospadius repair surgery. Materis and Methods At total of 64 pediatric patient 1 to 3 years old with American society of Anethesiologist (ASA) status | to |‖, undergoing hypospadius repair surgery were prospectively randomized into two groups, Group 1 received levobupivacaine 0.25% only 1 ml/kg plus 1 ml normal saline and group 2 received levobupivacaine 0.25% 1 ml/kg plus 0.1 mg/kg in 1 ml normal saline. The primary outcome of the study were time to first analgesia request, total consumption of rescue analgesia and the FLACC scale (face, legs, activity, cry and consonlability). The secondary outcome were heart rate (HR), mean arterial blood pressure (MAP), Oxygen saturation, occurrence of complications (respiratory depression, pruritis, xerostomia and postoperative nausea and vomiting). Results During surgery adequate intraoperative analgesia was defined by hemodynamic stability. An increase in the HR or MAP within 15 minutes greater than 15% compared to the baseline values obtained before skin incision recieved a rescue opioid in the form of fentanyl 5 mcg /kg and was excluded from the study. The difference between the two groups regarding time to first analgesia request was highly significant, group 1 (7.28±1.07), group 2 (11.59±2.54) (p &amp;lt; 0.01).The comparison between the two groups regarding the total consumption of rescue analgesia was also significant, group 1 (23.47±8.17), group 2 (19.23±7.31) (p &amp;lt; 0.05). There was statistically significant increase in FLACC in group 1 than group 2 at 30 min and up to 8 hours. There was no significant decrease in HR or MAP in group 2 more than group 1 except between 20 min and 8 hours. There was no statistically significant difference found between two studied groups regarding oxygen saturation regarding intraoperative and postoperative follow up. No patients in both groups had respiratory depression, xerostomia or pruritis.Few patients (3 _4) had postoperative nausea and vomiting with no statistically significant difference between the two groups. Conclusion The combination between nalbuphine and Levobupivacaine was valuable as regarding efficacy and safety profiles in pediatric analgesia. The intensity and duration of analgesia were remarkable compared to levobupivacaine alone. Fortunately, there were no side effects of systemic hazards recorded from systemic absorption of nalbuphine. To recommend considering nalbuphine as one of the valuable adjuvants to levobupivacaine in epidural analgesia according to its efficacy and safety profile.

Ultrasound-guided scalp nerve block in anesthesia of children receiving cranial suture reconstruction

ObjectiveAnalgesia is very important for children with craniosynostosis who are undergoing cranial suture reconstruction. This study investigated the effectiveness and safety of an analgesic technique based on scalp nerve block combined with general anesthesia versus general anesthesia alone.MethodsThis was a single-center, prospective, randomized, controlled study. A total of 60 children aged 6-24 months who underwent cranial suture reconstruction were randomly divided into two groups: Group A (general anesthesia combined with scalp nerve block) and Group N (general anesthesia). The hemodynamics were recorded preoperatively, at 5 min after incision and at 1, 6 and 12 h after surgery; the pain was scored at 1, 6 and 12 h after surgery, and blood glucose was detected at 1 h after surgery.ResultsThe mean arterial pressure and heart rate at 5 min after incision and 1 h after surgery in Group N were higher than those in Group A; the blood glucose and FLACC score in Group N were higher than those in Group A; and the number of postoperative analgesic pump presses were also significantly increased in Group N.ConclusionPreoperative scalp nerve block can reduce hemodynamic fluctuation and postoperative pain in children undergoing cranial suture reconstruction for craniosynostosis. Thus, it can be safely and effectively applied in the anesthesia of these children.

Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa.

Postoperative pain is one of the most prevalent complications following surgery, and more than 47% of surgical patients endure postoperative discomfort worldwide. In Africa, due to resource shortages and other issues, postoperative pain is substantially more common when compared to developed countries. Severe postoperative pain has many negative effects, including possibly death, which can burden both individuals and society as a whole. Therefore, effectively controlling postoperative pain is becoming increasingly important. To enhance the effectiveness of future pain management, a thorough analysis of the current reasons for inadequate postoperative pain management is necessary. In this article, the present situations of occurring postoperative pain, children's postoperative pain, and pain management in Africa are reviewed, based on relevant and recent literature. In particular, the reasons for inadequate postoperative pain management in Africa are detailed in this article from five perspectives: the inadequate assessment of postoperative pain, the knowledge gap among medical professionals, the patients' misconceptions, the scarcity of resources, and the lack of medications. Additionally, we offer appropriate solutions following various factors.

Effect of Prophylactic Vitamin D Supplementation on Postoperative Pain and Sedation in Children with Mental Motor Retarded Who Undergoing Dental Treatment Introduction

The frequency of vitamin D deficiency is higher in children with mental motor retardation(MMR). We aimed to investigate the effect of vitamin D supplementation on postoperative pain in children with MMR who underwent dental treatment under general anesthesia. &#x0D; Materials-Methods: Dental treatment was planned for a total of 62 patients with MMR, aged 7-17 years. Participants were divided into two groups. Children were prescribed vitamin D (600 IU of vitamin D per day) or Saline. Serum vitamin D levels were measured. Participants continued to intake oral vitamin D 600 IU (Group D) or 2ml saline (Group C) throughout 12 weeks. All participants were observed postoperative 1st hour, and Non-communicating Children's Pain Checklist–Postoperative Version (NCCPC-PV), Ramsay sedation scores, length of stay in post-anesthesia care unit, and analgesic requirements were recorded.&#x0D; Results: The study was completed with fifty children (35 in Group D, 15 in Group C). Serum vitamin D levels were higher in Group D than Group C at 12 weeks(p=0.007). Vitamin D deficiency was found at 13 patients (37.1%) and 6 (40%), and vitamin D sufficiency was found 18 (51.4%) and 7 (46.7%) in Groups D and C, respectively at first admission. There was statistically significant difference between groups in NCCPC-PV score at 15th, 30th and 60th minutes in PACU(p

Post-operative pain in children: Comparison of pain scores between parents and children.

To compare the relationship between parent-child postoperative pain scores and explore the factors that led to the difference in the score. Convenience sampling was used to select children and their parents who were 5-14 years old and scheduled for elective surgery as study subjects. When the child returned to the ward after surgery, the parent and child used the pain assessment tool to score the child's postoperative pain, respectively. A total of 214 children and their parents were included in the study. The results showed that the postoperative pain scores of parents and children were 3.69 ± 2.47 and 4.05 ± 2.90, respectively, and there were differences between the scores (P < 0.05). The results of multiple linear regression indicated that whether the child used Patient-Controlled Analgesia, different types of surgery and parents' pre-operative anxiety may be the reasons for the differences in parent-child scores. The parents' pain scores differed from their children's pain scores. If health-care professionals wanted to use the parents' pain score to replace the child's pain score, consideration should be given to whether children used patient-controlled analgesia, different types of surgery and the parents' pre-operative anxiety on the parents' pain score.

Comparison of analgesic efficacy of topical tramadol versus topical lidocaine in the control of postoperative pain in children after tonsillectomy: A randomized double-blinded clinical trial

Background and aim Tonsillectomy is considered one of the most frequent minor surgeries conducted on a day-case basis on children, and usually associate with pain and sore throat. This study aimed to compare the effect peritonsillor tramadol and lidocaine in pain alleviation after tonsillectomy in pediatrics. Patients and methods This prospective, randomized, double blind, controlled clinical study included 80 children, aged 4–15 years. They were distributed into two groups; Group T (n=40) patients received swabs soaked with tramadol 5% diluted with saline 0.9% up to 10 ml; group L (n=40) patients received swabs soaked with ledocaine 2% 2 mg/kg diluted with saline 0.9% up to 10 ml. Post operative pain scores, bleeding, nausea, vomiting, sore throat, otalgia, fever, halitosis, and trismus were recorded. Results Pain score was significantly reduced in the lidocaine arm within two hours after surgery, compared to the tramadol arm (P&lt;0.05). The mean modified VAS score at day 7 was significantly reduced in the tramadol arm, compared to lidocaine arm (1.21 Vs 2.42, P&lt;0.05). No significant difference between the two arms was reported, in terms of postoperative nausea and vomiting, halitosis, fever and otalgia. More serious complications like post-tonsillectomy bleeding or trismus were not reported in either groups Conclusion Topical 5% tramadole and lidocaine has a significant value in post tonsillectomy analgesic effect. Lidocaine had rapid onset at 15 min and duration prolonged up to 2 hours. Tramadol had delayed onset and prolonged duration from 4 hr up to 7 days.

Assessment of postoperative pain in children with computer assisted facial expression analysis

PurposeThe present study was conducted to evaluate the use of computer-aided facial expression analysis to assess postoperative pain in children. Design and methodsThis was a methodological observational study. The study population consisted of patients in the age group of 7–18 years who underwent surgery in the pediatric surgery clinic of a university hospital. The study sample consisted of 83 children who agreed to participate and met the sample selection criteria. Data were collected by the researcher using the Wong Baker Faces pain rating scale and Visual Analog Scale. Data were collected from the child, mother, nurse, and one external observer. Facial action units associated with pain were used for machine estimation. OpenFace was used to analyze the child's facial action units and Python was used for machine learning algorithms. The intraclass correlation coefficient was used for statistical analysis of the data. ResultsThe pain score predicted by the machine and the pain score assessments of the child, mother, nurse, and observer were compared. The pain assessment closest to the self-reported pain score by the child was in the order of machine prediction, mother, and nurse. ConclusionsThe machine learning method used in pain assessment in children performed well in estimating pain severity.It can code facial expressions of children's pain and reliably measure pain-related facial action units from video recordings. Application to practiceThe machine learning method for facial expression analysis assessed in this study can potentially be used as a scalable, standard, and valid pain assessment method for nurses in clinical practice.

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review.

Laparoscopic appendectomy (LA) is one of the most commonly performed surgical procedures in children and is associated with extreme postoperative discomfort due to peritoneal inflammation and infection. The main objective of this study was to investigate the effects of postoperative pain (POP) in children after laparoscopic appendectomy. Articles describing or evaluating the control of POP in children with LA were considered eligible. All available literature such as randomized controls, prospective controls, retrospective as well as clinical studies were considered. A comprehensive search was performed in PubMed, Medline, Embase, Cochrane Library, Clinical trials.gov, and Google scholar. The initial search took place on 23 April 2021, and was updated on 24 August 2021. There were no language or date restrictions. Each of the included articles was evaluated separately by two independent reviewers. Additional papers were found by searching the reference lists of eligible studies. Eighteen papers were considered. All papers, and many of them used different methods to treat POP in children undergoing LA, such as lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis blockade (UGTAP), ultrasound-guided quadratus lumborum blockade (UGQLB), and comparison of open appendectomy (OA) with local anesthetics in relation to POP management in children. Laparoscopic appendectomy is the surgical procedure preferred by clinicians compared with open appendectomy in children. A multimodal analgesic approach is optimal and efficient surgical techniques such as UGBRSB, UGQLB, and UGTAP block might significantly impact POP in children except that there are contraindications. Dexmedetomidine proved to be an effective adjuvant that can enhance the effect of local anesthetics. The lack of a sufficient number of studies may be a factor affecting our confidence in the results of this study. Therefore, further evidence-based randomized control trials with a large sample size are needed to provide clarity.

The recovery of upper limb function and postoperative pain in children with lateral humeral condyle fractures were examined retrospectively in relation to the effects of brachial plexus block given in conjunction with general anesthesia

ObjectiveTo assess in retrospect the effects of brachial plexus block and general anesthesia on children with lateral humeral condyle fractures in terms of postoperative pain and return of upper limb function.MethodsRandomly allocated to either the control group (n = 51) or the study group (n = 55) were children with lateral humeral condyle fractures who were admitted to our hospital between October 2020 and October 2021, depending on the surgical anesthetic technique used. The research group had internal fixation surgery with brachial plexus block in addition to anesthesia on the basis of the control group, whereas both groups of children underwent the procedure with general anesthesia alone. Postoperative pain degree, upper extremity functional recovery, occurrence of adverse reactions, etc.ResultsThe study group had shorter mean times for surgery, anesthesia, propofol dose, return to consciousness, and extubation than the control group did at every measure of statistical significance. The T2 heart rate (HR) and mean arterial pressure (MAP) were both significantly lower than the pre-anesthesia HR and MAP, and the T1, T2, and T3 HR and MAP were all significantly lower in the study group compared to the control group (P < 0.05). The difference between the SpO2 values at T0 and T3 was not statistically significant (P > 0.05); the VAS scores at 4 h, 12 h, and 48 h after surgery were higher than those at 2 h after surgery, and reached the peak at 4 h after surgery; within 2 h, 4 h, and 12 h of surgery At 48 h, the study group had substantially lower VAS ratings than the control group (P < 0.05). Post-treatment Fugl–Meyer scale scores were considerably higher across the board compared to pre-treatment levels in both groups. When compared to the control group, individuals who participated in the flexion-stretching coordinated exercise and the separation exercise had significantly better ratings. Electrocardiogram, blood pressure, respiratory circulation, and hemodynamic parameters all remained within normal limits during the surgical procedure. The study group had a 9.09% reduced incidence of adverse events compared to the control group. 19.61% (P < 0.05).ConclusionWhen used in conjunction with general anesthesia, brachial plexus block can help children with lateral humeral condyle fractures regulate perioperative signs, maintain their hemodynamic level, lessen postoperative pain and unpleasant reactions, and improve the function of their upper limbs. Functional recovery, with high safety and effectiveness.

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 &lt; 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.

Study to Assess the Knowledge and Practice of Pediatric Nurses Regarding Postoperative Pain Management in a Selected Hospital, Tamil Nadu, India

Abstract:Background : Children continue to experience unrelieved moderate to severe pain post operativelydespite the evidence to guide practice being readily available. Objectives to ascertain how nursesactually manage post operative pain in children and whether pain management practices adhere tocurrent best practice guidelines.1Materials and Methods: The sample size was 69 from chettinad hospital and research institute. Theresearch design used in this study is Quantitative descriptive design. non-probability convenientsampling technique will be used to select the samples.Standardized questionare and checklist was used to collect data.There data was analyzed and tabulated.Result : study shows Starting with age group majority of nurses about 72.5% were under the age groupof 20 to 29. Among the nurses, majority about 63.9% were female, male nurses were very lesscomparatively. About 70% of pediatric nurses were inadequate in knowledge and 30% of pediatricnurses were moderate in knowledge. About72.5% of nurses were good in practice and 27.5% of nurses were moderate in practice. There is noassociation between the selected demographic variables and the level practice of pediatric nursesregarding post operative pain management in children.