Postoperative Pain Management In Children Research Articles

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.

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.

Parental Postoperative Pain Management Perceptions, Attitudes, and Practices in Pediatric Limb Fractures

BackgroundPost-surgical pain in children is common, severe, and inadequately controlled. An effective model should involve the participation of parents. AimsTo investigate parental perceptions, attitudes, and practices in postoperative pain management in children with limb fractures and analyze the factors affecting parental practices. DesignThis was a descriptive cross-sectional study. SettingsResearch was conducted at a tertiary Children's Hospital Affiliated with Soochow University. ParticipantsParents whose children (age, 6–18 years) underwent orthopedic fracture surgery between January 1, 2020, and August 31, 2020, were recruited using purposive sampling. MethodsThe parents were asked to complete self-report questionnaires: “Pain Management Knowledge and Attitudes Questionnaire” and “Parents’ Use of Pain Relief Strategies Questionnaire.” The Wong–Baker Faces Scale was used to measure pain intensity in children. The Mann–Whitney U test, Kruskal–Wallis H test, and correlation and regression analyses were used for statistical analyses. ResultsData of 180 parents were collected. Of the participants, 80.6%, 78.3%, and 71.7% had low-to-moderate scores for knowledge, general attitudes, and use of pain relief strategies, respectively. Moreover, 93.9% of parents had moderate-to-high scores for negative attitudes toward medication, despite 89.5% of them reporting moderate-to-high pain intensities in their children (median proxy-report of pain intensity, 7.0 [3.00]). Multivariate linear stepwise regression showed that parents’ use of pain-relief strategies was related to their general attitudes, knowledge, and sex. ConclusionsMost parents had low-to-moderate scores for perceptions and general attitudes toward children’s postoperative pain management, and use of pain relief strategies. Moreover, they lacked knowledge of and had negative attitudes toward pain assessment and analgesics, which significantly impacted their practices. Clinical ImplicationsClinical pediatric nurses should provide appropriate support for the entire family of the child. Moreover, to enhance parental practices, they should develop targeted parental education programs for pain management, particularly regarding pain assessment tools and pain medications.

The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

Ineffective post-operative pain management in children may be associated with chronic pain. 98 pediatric patients aged 6 months to 12 years who underwent caudal levobupivacaine for hypospadias surgery were evaluated retrospectively. The patients who received additional intravenous clonidine were added in group 1; the patients who received additional intravenous morphine were added in group 2, patients who received additional caudal clonidine was added in group 3, and patients who received additional caudal morphine was added in group 4. CHEOPS score was assessed 1, 6, 12 and 24 hours after the operation and patients with score 6 or higher were determined. At the 1st hour, there were 8 cases in the intravenous morphine group (40%), 5cases in the intravenous clonidine group (25%), and 3 cases in the caudal morphine group (15%). At the 12th hour, there were 5 cases in the intravenous morphine group (25%), 10 cases in the intravenous clonidine group (50%), and 4 cases in the caudal morphine group (20%). At the 24th hour, there were 10 cases in the intravenous morphine group (50%), 10 cases in the intravenous clonidine group (50%), 9 cases in the caudal morphine group (45%) and 2 cases in the caudal clonidine group (10%) (p<0.05). There was no difference between the groups in terms of sedation scores at all hours (p>0.05). The lowest pain scores at the 1st, 12th, and 24th hours were recorded in the caudal clonidine group. It had the lowest pain scores at 6 hours. By these methods, in favor of the clonidine group, we agreed that the analgesia lasts for approximately 12 hours postoperatively, so the postoperative stress that the children and their families have can be minimized.

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.

Parental involvement in postoperative pain management among children in a urology ward: A best practice implementation project.

Postoperative pain has adverse effects on children with urological problems, including sleep disturbances, incision dehiscence, bleeding and delayed recovery. Accurate parental assessment of children's behaviours and responses could help to manage postoperative pain. We aimed to implement evidence-based practice for parental involvement in a urology ward, to increase parents' participation in children's postoperative pain management. The project was conducted in a paediatric urology ward using the framework and methods of the Fudan University Evidence-Based Nursing Center's Evidence-based Continuous Quality Improvement Model. Fifteen audit criteria were used to represent best practice recommendations for parental involvement in postoperative pain management. A pre-implementation audit was conducted with 211 randomly sampled children and parents. Obstacles, promoting factors and key strategies were analysed, and evidence-based interventions implemented to improve compliance. A follow-up audit using the same audit criteria was conducted with 202 children and parents to assess the effect of targeted strategies on compliance with best practice. The SQUIRE guidelines were followed. At the baseline audit, compliance with the evidence-based criteria was 0%-71.5%; only five audit criteria achieved a compliance rate > 60%. After best practice implementation, the follow-up audit showed compliance improvements for all criteria; compliance for three criteria improved to 100%. This best practice implementation project improved parents' participation in children's postoperative pain management. The findings demonstrate how audits can promote best practice in postoperative pain management for children. Additional studies will be conducted to address children's postoperative life quality based on best practice.

Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study

Background: Postoperative pain management in children can be effectively controlled using regional analgesic techniques. In general, neuraxial blocks pose a higher risk of adverse effects and complications in comparison to peripheral nerve blocks. Recently, both quadratus lumborum block (QLB) and erector spinae plan block (ESPB) have been used to achieve adequate postoperative analgesia in children. We compared the efficacy of both in postoperative pain management after laparoscopic abdominal surgery.
 Methodology: Eight five patients with laparoscopic abdominal surgery received either bilateral QLB or ESPB at the level of T8 transverse process with 0.5 ml/kg of 0.25% bupivacaine to achieve adequate postoperative analgesia. FLACC score was used to assess pain score after surgery and the need for rescue opioid analgesia.
 Results: The average dose of fentanyl was lower and the time to the first dose of rescue analgesic was longer in QLB group when compared to ESPB group. In addition, FLACC scores were significantly lower in QLB group in comparison to ESPB group at the 6th, 8th, 12th and 20th h after surgery.
 Conclusion: Quadratus lumborum block can provide longer and more effective postoperative analgesia in pediatric patients following laparoscopic abdominal surgery in comparison to erector spinae plan block.
 Citation: Taman HI, Saber HIES, Farid AM, Elawady MM. Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study. Anaesth. pain intensive care 2022;26(5):602-607; DOI: 10.35975/apic.v26i5.2017

Bibliometric and Visual Analysis of the Current Status and Trends of Postoperative Pain in Children from 1950-2021.

BackgroundPostoperative pain in children has been overlooked for a long time. The knowledge structure, research hotspots and trends related to postoperative pain in children are unclear and have not been systematically summarized.PurposeWe aimed to analyze the current state of research on postoperative pain in children and to conduct in-depth mining of the knowledge structure.MethodsThe PubMed database for publications on postoperative pain in children between 1950 and 2021 was searched. Bibliographic Item Co-Occurrence Matrix Builder (BICOMB) was performed to obtain the co-word matrix and co-occurrence matrix. The H-index method was used to extract high-frequency main Medical Subject Headings (MeSH) terms/subheadings.ResultsThe high-frequency MeSH terms were analyzed by biclustering, strategic diagram and social network analyses. Totally, 4022 publications were retrieved. The analysis showed that 60 countries or regions published relevant documents, with the United States publishing the most significant number of papers. Totally, 811 journals published relevant papers, with Pediatric Anesthesia ranking first. Moreover, we extracted 43 high-frequency main MeSH terms/subheadings and clustered them into five categories: overview, aetiology and epidemiology, pharmacotherapy, opioid administration and dosing, and prevention and control of postoperative pain in children.ConclusionPharmacological treatments, pain prevention and control are the focus of research and are becoming increasingly mature. Opioid stewardship and regional anesthesia is the trend and focus of future research. Our study offers a better understanding of the current status and knowledge structure of postoperative pain in children and provides a reference for improving postoperative pain management in children in the future.

Ibuprofen for acute postoperative pain in children

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of ibuprofen (any dose) for acute postoperative pain management in children compared with placebo or other active comparators. To compare ibuprofen administered by different doses, routes (e.g. oral, intravenous, etc.), or strategies (e.g. as needed versus as scheduled).

DEVELOPMENT OF THE INDONESIAN VERSION OF MULTIDIMENSIONAL ASSESSMENT OF PAIN SCALES (MAPS-I) TO MEASURE POST OPERATIVE PAIN IN CHILDREN

Currently, postoperative pain management in children has not been adequate. There are about 40% of children get postoperative pain of moderate to severe scale. Ineffective pain management will cause chronic persistent postsurgical pain (CPSP) with an incidence of 50% in children. The fact is that postoperative pain management in children is due to the difficulty of assessing children's pain. The method used to assess pain in children is to use a multidimensional self-report to assess the scale of postoperative pain in children. The Multidimensional Assessment of Pain Scale instrument is an instrument that assesses postoperative pain in children multidimensionally but has not been translated into Indonesian validly and reliably. The purpose of this study was to determine the development of the Multidimensional Assessment of Pain Scale to measure postoperative pain in children. The Indonesian version of the Multidimensional Assessment of Pain Scale (MAPS-I) instrument consists of 5 categories with 3 scoring scores from 0-2. This research is quantitative research with a cross sectional design. The validity test that was measured was content validity and construct validity. The reliability test was measured using Cronbach Alpha. The MAPS-I instruments with postoperative child respondents showed good validity with Aiken's value range of 0.83-1. The results of the construct validity of the MAPS-I instrument are all valid items. The results of the factor analysis stated that there were 2 valid items (factor loading>0.5) with 2 factors formed (Eigenvalue>1). Internal consistency reliability shows the results of Cronbach Alpha of 0.804 (> 0.482) for postoperative child respondents. The MAPS-I instrument can be used as an instrument to measure the level of pain in postoperative children that is valid and reliable.
 Keywords: Children; Postoperative Pain; Multidimensional Assessment of Pain Scale

Quadratus Lumborum Block for Upper Tract Urological Surgery in Pediatric Patients

Abstract Objective Among regional blocks, the quadratus lumborum fascial plane block (QLB) has been well described, but the description of its use and efficacy for pediatric patients undergoing upper abdominal urologic surgery is limited. We present a case series examining the use of the QLB for postoperative pain management in children undergoing upper tract surgery. Methods From August 2019 to August 2020, through a chart review, we identified 5 patients who had undergone a QLB for upper urinary tract surgery via a flank incision. Posterior QLB was performed after induction of general anesthesia. A single injection of 0.5mL/kg of either 0.25% or 0.5% ropivacaine with 1mcg/kg of clonidine was administered. Patients received fentanyl IV (1 mcg/kg), and acetaminophen IV (15mg/kg) as adjuvants during the operation. Postoperative pain was managed with oral acetaminophen and ibuprofen. Results The average postoperative pain score during the entire admission was 1, with the lowest being 0 and highest, 3. No administration of rescue narcotics was required in the postanesthesia care unit or on the floor. The average length of stay ranged from 0 to 1 day. No complications associated with the regional QLB were identified. Conclusions Our series suggests the QLB may be considered as a regional anesthetic option to minimize narcotic requirements for children undergoing upper abdominal urological surgery via flank incision. Additional studies are needed to compare the efficacy of the QLB versus alternate regional anesthetic blocks for upper tract urological surgery via flank incision in children and to determine effective dosing and use of adjuvants.

Impact of Parental Primary Spoken Language on Postoperative Pain Management in Children, a Retrospective Cohort Study.

Background: Healthcare providers encounter varying languages every day in patient care. The goal of this study was to examine whether a difference exists in pain scoring and treatment amongst pediatric patients whose families’ primary language was not English. We hypothesized that patients of both Arabic-speaking (AS) and Spanish-speaking (SS) backgrounds received higher pain scores and higher daily opioid equivalents (OEs) postoperatively compared to English-speaking (ES) patients. Methods: This was a retrospective cohort study of patients undergoing surgery for treatment of various esophageal and airway disorders from 2014 to 2019. Records were queried for patients undergoing thoracotomies for treatment of esophageal and airway disorders. Analysis was focused on the three most common languages in this selected population: English, Arabic, and Spanish. Propensity score matching was utilized for comparisons of pain scores between AS, SS, and ES patient groups. Primary outcomes were opioid equivalents (OEs) and pain scores postoperatively. Multivariable median regression analysis was used to perform an adjusted comparison of pain scores as well as OEs. Results: A total of 610 patient encounters were included in our analysis. In propensity matched analysis, there were no significant differences in OEs between all groups postoperatively. However, statistically significant higher pain scores were reported in the ES group matched AS groups. Conclusions: Language differences did not lead to difference in pain assessment and treatment.

Postoperative Pain in Children

Postoperative pain is an acute pain that starts with surgical trauma and gradually decreases with healing of the tissue. The mechanism of pain perception in the pediatric population is different and poorly understood. Difficulties in defining and grading pain in pediatric patients also complicate treatment. Postoperative pain management in children should be planned with a multidisciplinary and multimodal approach. In this article, it is aimed to review up-to-date information on pediatric postoperative pain management.

Interactions between children, parents and nurses during postoperative pain management: A grounded theory study.

To explore the interactions between children, parents and nurses during postoperative pain management. Despite the growing evidence relating to postoperative pain management in children and relevant practice guidelines, children still experience moderate to severe pain after surgery. One factor could be related to the relatively unexplored child-parent-nurse interaction. A qualitative constructivist grounded theory methodology. Data were collected from a paediatric hospital in the United Kingdom. Ten children aged between 6 and 11years old who had undergone surgery, 11 parents and 10 nurses participated. Methods included face-to-face semi-structured interviews. Data were analysed using constant comparison technique, memos and constructivist grounded theory coding levels. The COREQ guidelines were followed for reporting. Three concepts emerged from data, "Parents as a communicator for child-nurse interaction", "Parents' emotional turmoil in child-nurse interaction", and "Parents' actions in child-nurse interaction" which constructed the substantive theory of child-parent-nurse interaction during postoperative pain management: "Facilitating or Inhibiting Interactions: Parental Influence on Postoperative Pain Management". The findings highlight an absence of a three-way interaction between children, parents and nurses and a dyadic interaction process between children and nurses was not apparent. Instead, child-parent-nurse interactions were constructed around two dyads of child-parent and parent-nurse interactions with child-nurse interaction constructed via parents. Parents, as a communicator, influenced the entire postoperative pain management processes between children, parents and nurses by facilitating or inhibiting the interaction processes. This study identifies potentially important evidence about the unique position parents hold between their child and nurses as a central pivotal communicator during children's postoperative pain management. This study may help to explain how and why postoperative pain management remains suboptimal. The substantive theory could support improvements in the management of postoperative pain through a much wider recognition of parents' central pivotal communicator role and the complexity of these child-nurse interactions.

Perioperative opioid use in paediatric inguinal hernia patients: A systematic review and retrospective audit of practice

BackgroundOpioids play a major role in postoperative pain management in children, but their administration remains an under investigated topic. This study aimed to describe perioperative opioid prescribing practices for paediatric inguinal hernia patients in the literature and at The Royal Children's Hospital (RCH) in Melbourne, Australia. Material/methodA systematic review of English articles (published from 2009 to 2019) was conducted on paediatric (0–18y) inguinal hernia patients who received a postoperative or discharge opioid prescription, or both. The review was combined with a retrospective audit of RCH patients. Demographic, surgical, and analgesic details were collected from the electronic medical records. ResultsFifteen studies (n = 1166; combined mean age 4.93y) met the systematic review criteria. The percentage of patients receiving opioids postoperatively overall ranged from 3.33–100%, and doses ranged from 0.07 to 0.35 mg/kg oMEDD. At the RCH, perioperative opioid use was analyzed from 150 inguinal hernia patients (male – 113, median age – 3 months old). Postoperatively, 26 (17.3%) patients received opioids. The most commonly administered opioids were fentanyl (0.04–0.60 mg/kg oMEDD) in the post anaesthesia care unit and oxycodone (0.14–0.40 mg/kg oMEDD) in the first 24 h postoperatively. Older age at surgery, female sex and absence of regional anaesthesia were significantly associated with higher risk of total opioid use. No patients received an opioid prescription at discharge. ConclusionThere is demonstratable variability in opioid prescribing practices for paediatric inguinal hernia patients as described in the literature. At our institution opioids were not used frequently in postoperative period.

The effectiveness of a parent participation in postoperative pain management programs for children in a urology ward: A randomized controlled trial.

Postoperative pain has adverse effects on children after urology treatment, including sleep disturbance, incision dehiscence, bleeding, and delayed recovery. Parents, as the most direct caregivers of children, can make accurate assessments of children´s personal behaviors and responses, which is very important for the management of postoperative pain in children. The purpose of the current study was to develop a Parent Participation in Postoperative Pain Management Program for children in a urology ward and to evaluate its effects on children's postoperative pain scores and other outcome indicators. This research comprised two phases. The first phase was the development of a Parent Participation in Postoperative Pain Management Program. The second phase was a randomized controlled trial between two groups, and was carried out in a 45-bed inpatient urology ward of a tertiary children's hospital in China. In the trial, 211 children and their parents were randomly selected as a control group between July 1 and August 15, 2019, and 202 children and their parents were randomly selected as an intervention group between August 16 and September 15, 2019. Following the framework and methods of the Evidence-based Continuous Quality Improvement Model developed at Fudan University Evidence-Based Nursing Center, we systematically gathered evidence regarding parental involvement in postoperative pain management in children to construct the program. To evaluate the program's effectiveness, the control group performed routine postoperative pain management, while the intervention group underwent the Parent Participation in Postoperative Pain Management Program. The management period was during hospitalization, and generally ranged 3-7days. The Statistical Table of Pain Assessment for Children after Urology was employed by researchers. The results revealed no significant differences in demographic characteristics between the two groups of children and their parents. Children's pain scores during dressing removal (Z=-3.108, p=0.002), at discharge (Z=-2.185, p=0.029) and during catheter removal (Z=-6.553, p=0.000) were significantly lower in the intervention group compared with the control group. The Parent Participation in Postoperative Pain Management Program was found to be effective for alleviating postoperative pain scores among children, and provided useful information regarding postoperative pain management in children involving four aspects of parental involvement: cognition, guidance, documentation and support.

Nerve Blocks for Postoperative Pain Management in Children Receiving Subcutaneous Implantable Cardioverter-Defibrillators: A Case Series.

Subcutaneous implantable cardioverter-defibrillator (S-ICD) placement may cause significant postoperative pain. Limited research exists on regional anesthesia for pediatric S-ICD placement. This case series examined transversus thoracic plane blocks (TTPBs), pectointercostal fascial plane blocks (PIFBs), pectoralis nerve I and II blocks, paravertebral, serratus anterior plane, and erector spinae plane blocks (ESPBs) in 10 children receiving S-ICDs. Parasternal nerve blocks consisting of TTPB or PIFB and left ESPB appeared to provide adequate pain control. These children had reduced opioid consumption, lower mean pain scores, longer delay in first postoperative analgesic, and no complications. Regional anesthesia may reduce pain after pediatric S-ICD implantation.

Nerve Blocks for Postoperative Pain Management in Children Receiving a Subcutaneous Implantable Cardioverter-Defibrillator: A Case Series: Retraction.

Nerve Blocks for Postoperative Pain Management in Children Receiving a Subcutaneous Implantable Cardioverter-Defibrillator: A Case Series: Retraction.

Perioperative analgesia and assessment of pain in children (literature review)

Annotation. Adequacy of postoperative analgesia and pain assessment remains a pressing issue in children. In order to provide effective pain management to this population, it is important to consider some specific features such as the age of a child, cognitive imparement, mechanisms of pain, and traumatic cimcumstances resulted in nociceptive responses. Therefore, it is essential for clinicians to be able to choose the appropriate tools for pain assessment in different age groups of children and clinical situations, and to interpret the obtained data correctly. Hence, our study aimed to systematize existing problematic aspects of postoperative pain assessment is children and to analyze the evidence on perioperative analgesia in the paediatic practice. For this purpose, we systematically searched MEDLINE, the Cochrane Library and Google Scholar for trials published between 2002-2020. We paid particular attention to the correct choice of pain assessment tools in children of different age groups, and proper interpretation of the data obtained. The study contains the updated recommendations for postoperative pain management in children. There is a special emphasis on priority of multimodal analgesia in children. Analysis of recent publications shows that newborns and children under 5 years of age should be assessed with comprehensive pain scales that include behavioral characteristics and physiological parameters. It is advisable to use self-assessment pain scales for children older than 5 years of age. In order to manage the acute pain effectively, it should be assessed at least every 4-6 hours. Sufficient perioperative analgesia promotes rapid rehabilitation and prevents children from postoperative homeostatic disruption.

Anesthetic Challenges During Video-Assisted Thoracoscopic Surgeries for Pediatric Empyema Thoracis: A Case Series

Video-assisted thoracoscopic surgery (VATS) is a less invasive approach for thoracoscopic surgery providing better visualization through minimal access. In addition, it offers less postoperative pain, fewer operative complications, and shortened hospital stay. These advantages make VATS ideal for the pediatric age group. Various societies recommend the use of VATS for Stage 2 pulmonary empyema and also in some cases of early Stage 3 where the plane of cleavage exists between the pleura and the exudate. A well-executed one-lung ventilation (OLV) is necessary for a successful VATS; however, performance of OLV and postoperative pain management in children poses a challenging task for an anesthesiologist.