Pain Assessment Scale Research Articles

Content Validity of the Spanish Adaptation of the Premature Infant Pain Profile Revised

BackgroundTo the best of our knowledge, there are no validated neonatal pain assessment scales in Spanish. Given the need for such a scale, a study was undertaken to adapt and validate the Premature Infant Pain Profile-Revised (PIPP-R) scale. After translation and back-translation, content validity was addressed, a crucial phase in validation studies, in which researchers examine whether the items that make up the scale represent the content that the scale is intended to assess. AimsThe aim was to provide evidence for the content validity of the Spanish adaptation of the PIPP-R scale. MethodThe study used the Delphi technique with 10 experts. Data collection was anonymous and was conducted through an online platform. It was an ad hoc survey consisting of four questions, with a five-point Likert scale for each item on the scale and for the instruction table. An item-content validity index (I-CVI) and a scale-content validity index (S-CVI) were calculated for the analysis. ResultsAfter two rounds of the survey, all items exceeded an I-CVI of 0.9. The S-CVI value was 0.98 (±0.03) for the scale, and 1 for its instruction table. The kappa index yielded values indicating an excellent degree of agreement. ConclusionsThe Spanish version of the PIPP-R obtained a high degree of content validity according to the expert group and the Delphi technique.

Cost-effectiveness analysis of epidural morphine/ropivacaine treatment in patients with cancer pain.

Cancer pain is one of the main causes of human suffering, which can generate disabilities and compromise quality of life, giving rise to several psychosocial and economic consequences. This quantitative study sought to perform a cost-effectiveness pharmacoeconomic analysis to assess the impact of implanting epidural morphine associated with ropivacaine treatment in gastrointestinal cancer patients with pain that is difficult clinical control, compared with conventional oral treatment. The study population consisted of 24 patients with gastrointestinal neoplasia who underwent treatment for cancer pain that was difficult to clinically control. 12 patients each were recruited into the control and intervention groups, respectively. While patients in the control group were administered drug treatment orally, patients in the intervention group underwent a surgical procedure for subcutaneous implantation of a catheter that allowed epidural administration of morphine and ropivacaine. For pain assessment, the Visual Analogue Scale was applied. Data analysis had a descriptive character of costs, taking into account the costs for the year 2021. The study perspective was the Brazilian public healthcare provider, referred to as the Unified Health System (Sistema Único de-SUS in Portuguese). Costs were computed over the time horizon corresponding to the duration of treatment, from the first medical consultation (when the treatment was defined) to the end (end of treatment, disease progression, or death). Treatment duration was divided into three phases (first 60 days, support with palliative care, and end-of-life care). To assess the robustness of the economic analysis, sensitivity analyses were performed, considering the effectiveness of pain reduction on the Visual Analogue Scale, and a comparison of results using the median prices of pharmaceutical components used in the study. The mean age of patients was 59.3 years. The results from the cost-effectiveness analysis showed the epidural morphine/ropivacaine treatment to be more effective with regard to pain reduction on the pain scale, particularly for end-of-life care, when compared to the conventional oral treatment, however, at a significantly higher cost. From the accomplishment of this research, it was observed that the application of the pain assessment scale is a way to better interpret and understand the patient's pain, facilitating care planning and decision-making by health professionals, as well as monitoring the effectiveness of the proposed new treatment. To present a better cost-effectiveness ratio, a reduction in the cost of the new epidural technology or an increase in the value of the existing oral intervention would be required. However, the latter is not feasible and unlikely to occur. A value judgement to decide whether the incremental benefit associated with the use of the new intervention is worth the extra cost will have to be made by the healthcare provider. Interventions that can relieve cancer pain symptoms should be investigated continuously, in search of evidence to support clinical practice and promote better quality of life for patients.

Psycho-emotional status in patients with endometriosis-associated pain syndrome in various disease phenotypes

BACKGROUND: Patients with endometriosis-associated pain syndrome in combination with anxiety or depression have lower treatment effectiveness and satisfaction with both the disease itself and the pain syndrome compared to patients with pain syndrome but without depression or anxiety.
 AIM: The aim of the study is to assess the relationship between psychosocial status and endometriosis-associated pain syndrome in patients with different phenotypes of endometriosis using pain assessment scales, psychosocial state assessment scales, and quality of life assessment scales.
 MATERIALS AND METHODS: We examined 81 patients using a number of questionnaires: Visual Analogue Scale, Numeric Rating Scale, Hospital Anxiety and Depression Scale, Beck Depression Scale, Spielberger State-Trait Anxiety Inventory, and Short Form-36 quality of life assessment. The patients were divided into three groups: isolated adenomyosis (n = 39), adenomyosis combined with external genital endometriosis (n = 21), and the control group (n = 21).
 RESULTS: Our study has shown that patients with adenomyosis combined with external genital endometriosis had the highest scores on all questionnaires for assessing anxiety and depression, as well as a low quality of life in general, which significantly differed from those in the control group (p 0.05). The results in the group of women with isolated adenomyosis are not so unambiguous and, overall, somewhat better than in the group of patients with adenomyosis combined with external genital endometriosis, but significantly worse compared to the control group. When assessing the severity of dysmenorrhea, higher scores were also found in the group of women with adenomyosis combined with external genital endometriosis: 6.64 2.11 cm (Visual Analogue Scale) and 6.9 2.05 cm (Numeric Rating Scale), while in the group of women with isolated adenomyosis, the scores were 5.29 1.9 cm and 5.83 1.72 cm, respectively (p = 0.028). Women in the control group had no pain syndrome.
 CONCLUSIONS: Poor mental and physical health scores obtained in this study in women with external genital endometriosis dictate the need for an objective and multicomponent assessment of the psycho-emotional status in patients, followed by complex treatment and team management with related specialists.

Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study.

Equine pain scoring may be affected by the residual effect of anesthetic drugs. To compare pain scores in the hours immediately following anesthetic recovery to baseline pre-anesthetic scores in equine patients undergoing surgical and non-surgical procedures. Clinical observational study. Fifty adult horses undergoing anesthesia for surgical or non-surgical procedures were enrolled. Horses underwent pain scoring using the Composite Pain Score (CPS) and Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) prior to anesthesia (T0) and following anesthetic recovery to standing, every hour for 5 h (T1-T5). Data were analyzed using a generalized linear mixed effects model. A post-hoc Dunnett's test for multiple comparisons was performed for variables where an effect was detected. Mean (95% confidence interval) CPS scores for T0-T5 were 1.6 (1.2-2.0), 6.8 (6.0-7.6), 5.1 (4.3-5.9), 4.3 (3.4-5.2), 3.7 (2.8-4.6), and 2.8 (2.0-3.6) and EQUUS-FAP scores were 0.6 (0.3-0.9), 3.0 (2.5-3.5), 1.9 (1.6-2.2), 1.1 (0.8-1.4), 0.6 (0.4-0.8), and 0.7 (0.4-1.0), respectively. For the CPS, scores greater than 5, and for the EQUUS-FAP scores greater than 3, are consistent with minor pain. There was no effect of type of procedure (surgical vs non-surgical) on CPS or EQUUS-FAP scores. There was an effect of time with CPS scores significantly greater than baseline at T1-T5 and EQUUS-FAP scores significantly greater than baseline at T1 and T2. Discomfort caused by hoisting was not quantified and it was difficult to ascertain if this affected the results. Post-anesthetic pain scores may be influenced by the residual effect of anesthetic agents for as long as 5 h and 2 h for the CPS and EQUUS-FAP, respectively.

Cross-cultural adaptation, reliability, and validity of the Russian version of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0).

The most validated health-related quality-of-life (HRQOL) questionnaire specific to the metastatic spine cancer population is the Spine Oncology Study Group Outcomes Questionnaire version 2 (SOSGOQ2.0). The purpose of this study was to translate and validate a Russian version of the SOSGOQ2.0. The SOSGOQ2.0 was translated into Russian and cross-culturally adapted. In this study, 64 eligible patients completed the SOSGOQ2.0_RUS along with the EQ-5D 5 Level, SF-36 quality-of-life questionnaires, and visual analog scale for pain assessment scale (VAS). Internal consistency was measured using Cronbach's alpha, in which a score of 0.65 or higher is acceptable. Test-retest reliability was evaluated by examining the intraclass correlation coefficient (ICC). Included in this study were 64 Russian-speaking patients (median age 59 years) with metastatic spine disease. The most common primary tumors were breast, kidney, and prostate cancers. The overall Cronbach's alpha was 0.87, indicating high internal consistency. The overall ICC for the SOSGOQ2.0_RUS was 0.88 (95% CI 0.81-0.93), indicating high reliability and consistency of the measure. The physical function, pain, and mental health domains of the SF-36 moderately correlated with the same domains of the SOSGOQ2.0_RUS, with correlation coefficients ranging from 0.65 to 0.71. The SOSGOQ2.0_RUS is a reliable and valid questionnaire for assessing the HRQOL in patients with metastatic spinal tumors. The questionnaire showed high internal consistency, test-retest reliability, and good construct validity when compared with other established questionnaires.

Effect of Cryotherapy on Pain Associated with Chest Tube Removal after Thoracotomy

Context: Chest tube removal (CTR) is described as one of the worst feelings for critically ill patients after thoracotomy. Unrelieved pain causes undesired consequences that have adverse effects on patient quality of care. Analgesics usually manages CTR pain, but patients respond differently to drugs and might not provide complete relaxation. Cryotherapy is commonly applied as a non-pharmacological intervention for relieving CTR pain.
 Aim: This study aimed to evaluate the effect of cryotherapy on pain associated with chest tube removal after thoracotomy.
 Methods: This study was conducted in the cardio-thoracic critical care units at Cardiovascular and Thoracic Academy, affiliated to Ain Sham University Hospital. A purposive sample of 140 patients undergoing thoracotomy was included in this study. They were divided into control and study group (70 patients in each group). Data were obtained using the Chamber-Price Modified Pain Rating Scale (CPPRS), Standardized Linear Scale for Pain Assessment, and Modified McGill Pain Questionnaire-Short Form (MPQ-SF).
 Results: The results reveal that 50%, 67.1% of the control and study group patients were in the age group 51-≥60 years. 62.9, 81.4% of the control and study group were males. Besides, there were highly statistically significant differences regarding peripheral pulse, apical pulse, and respiratory rate throughout CTR pain assessment times and a highly statistically significant difference regarding blood pressure immediately after CTR between the study and control groups. Also, statistically significant differences regarding physiological and behavioral parameters, pain intensity, and quality (sensory and affective descriptors) were found between the study and control groups immediately and 30 minutes after cryotherapy was applied after chest tube removal.
 Conclusion: Cryotherapy effectively improved hemodynamic, physiological, and behavioral parameters, relieving pain intensity and improving pain quality after chest tube removal for patients with thoracotomy. The current study recommends conducting periodic in-service educational programs for critical care nurses regarding the benefits, methods, contraindications, and side effects of cryotherapy for relieving pain associated with CTR after thoracotomy. Motivate nurses in critical care units to use cryotherapy as a non-pharmacological therapy for relieving pain associated with chest tube removal.

Первинний хронічний біль як соматизація дистресу

Relevance. The direct functional significance of pain is to signal the action of a stimulus, damage to the integrity of the organism or its individual structures. A number of scientists have approached the study of pain as a physiological defense mechanism, during which we understand the principles of its emergence, course, localization, and ways to overcome pain sensations through pharmacological, physical, and instrumental methods. However, the problem of pain arises when the physiological substrate is absent or does not correspond to the strength or duration of the manifestation. This is where we can talk about pain of a psychogenic nature, which despite a number of studies that are currently underway, still remains difficult to treat. Objective. To improve the effectiveness of medical-psychological assistance by studying the nature and patterns of pain syndrome in patients with primary chronic pain with subsequent psycho-correction and the use of psychotherapeutic interventions. Methods. The study design was a monocentric randomized controlled trial with parallel groups. The study involved 14 individuals with primary chronic pain syndrome, which corresponded to ethical and deontological norms according to the principles set out in the Helsinki Declaration. The tools used in the study included the SPAASMS subjective pain assessment scale, the somatic symptoms questionnaire (SSS-8), the Bass-Darky aggressiveness and hostility level questionnaire (BDHI), as well as the Chaban O.S. quality of life assessment scale (CQLS). Results. At the completion of the study, a statistically significant difference was observed for all clinical parameters between the experimental and control groups. Comparison of the values of the scale in the experimental group on days 1 and 42 demonstrated statistically significant changes in all four indicators. However, this study reveals a limited sample, which in turn allows for expanding the sample size and investigating the phenomenon of applied interventions in future pilot studies, as the primary results provide a qualitative and positive trend in reducing the effects and impact of primary chronic pain, as well as improving the quality of life indicator. Conclusions. The results of this study confirm the effectiveness of psychological interventions, as well as psychological interventions for reducing the subjective sensation of pain syndrome, symptoms of somatization, aggressive and hostile reactions, and improving the quality of life in individuals suffering from primary chronic pain.

Efficacy analysis of enhanced recovery after surgery in laparoscopic-assisted radical resection of type I choledochal cyst.

The objective of this study was to investigate the feasibility and effectiveness of laparoscopic-assisted radical resection of type I choledochal cyst (CC) guided by the principles of enhanced recovery after surgery (ERAS). A retrospective cohort study of type I CC admitted to our hospital between May 2020 and December 2021 were analyzed, a total of 41 patients with choledochal cyst underwent surgery during this period and 30 cases were selected based on inclusion and exclusion criteria. Patients (n = 15) who received the traditional treatment from May 2020 to March 2021 were included in the traditional group. Patients (n = 15) who received ERAS from April 2021 to December 2021 were included in the ERAS group. Both groups underwent surgery performed by the same surgical team. Preoperative data of the two groups were recorded, and relevant data were statistically analyzed and compared. There was a statistically significant difference in the dose of opioids. Significant differences were observed between the ERAS and traditional groups in the results of the FLACC pain assessment scale on the 1st and 2nd day after surgery, time of gastric tube, urinary catheter and abdominal drainage tube removal, time of first defecation after operation, time of first eating after operation, time to reach full food intake, results of CRP, ALB, and ALT on the 3rd and 7th postoperative day, postoperative hospital stay, and total treatment cost. No significant differences were observed between the two groups in terms of gender, age, body weight, cyst size, preoperative CRP, ALB, ALT, intraoperative blood loss, operation time, and the number of cases converted to laparotomy. Neither the FLACC pain assessment scale on the 3rd day after surgery, the incidence of postoperative complications, nor the rate of readmission within 30 days showed significant differences. Laparoscopic-assisted radical resection of type I CC guided by the principles of ERAS is safe and effective for children. The ERAS concept demonstrated advantages over traditional laparoscopic surgery, including reduced opioid use, shorter time to first postoperative defecation, earlier resumption of postoperative feeding, shorter time to reach full feeding, shorter postoperative hospital stay, and lower total treatment cost.

Phase III, international, multicentre, double-blind, dose increment, parallel-arm, randomised controlled trial of duloxetine versus pregabalin for opioid-unresponsive neuropathic cancer pain.

TPS12146 Background: Management of neuropathic cancer pain (NCP) refractory to regular opioids remains an important challenge. The efficacy of pregabalin for NCP except chemotherapy-induced peripheral neuropathy has already been confirmed in two randomised controlled trials (RCTs) compared with placebo. Duloxetine offers the potential of analgesia in opioid refractory NCP. However, there are no RCT of duloxetine for the management of opioid-refractory NCP as a first line treatment. Both classes of drugs have the potential to reduce NCP, but there has been no head-to-head comparison for the efficacy and safety, especially given differing side effect profiles. Methods: An international, multicentre, double-blind, dose increment, parallel-arm, RCT. Eligibility criteria include: adult cancer patients experiencing NCP refractory to opioids; Brief Pain Inventory (BPI)-item 3 (worst pain) ≥4; Neuropathic Pain on the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale ≥12 despite of an adequate trial of regular opioid medication (≥60mg/day oral morphine equivalent dose). The study will recruit inpatients and outpatients in Japan and Australia. Participants will be randomised (1:1 allocation ratio) to duloxetine or pregabalin. Dose escalation is to day 14 and from day 14 to 21 is a dose de-escalation period to avoid withdrawal effects. Dose escalation schedule in each-arm is shown in Table 1. The primary endpoint is the mean difference in BPI item 3 over the previous 24 hours on day 14 between groups. Null hypothesis is there is no difference in BPI item 3 in the previous 24 hours on day 14 between both groups for patients with opioid refractory NCP. Comparison of the BPI item 3 on day 14 between duloxetine groups and pregabalin groups will be conducted using a two-sided Student’s t-test at a significance level of 5% according to the intention-to-treat principle. Point estimates and 95% CIs for the difference between two groups will be calculated. A sample size of 160 participants is required with 67 subjects enrolled to date. The DSMC last reviewed the trial in December 2022 and case accumulation expected to be completed by the end of 2024. Table 1：Dose escalation schedule in each-arm. Duloxetine Arm Stage 1 (Day 1-3): Duloxetine (30 mg) 1 capsule (morning) and Placebo 1 capsule (bedtime) Stage 2 (Day 4-7): Same as Stage 1 Stage 3 (Day 8-14): Duloxetine (30 mg) 1 capsule twice a day (morning and bedtime). Pregabalin Arm Stage 1 (Day 1-3): Pregabalin (25 mg) 1 capsule twice a day (morning and bedtime). Stage 2 (Day 4-7): Pregabalin (75 mg) 1 capsule twice a day (morning and bedtime). Stage 3 (Day 8-14): Pregabalin (75 mg) 2 capsules (150 mg) twice a day (morning and bedtime). Clinical trial information: ACTRN12620000656932 , jRCTs051190087.

Evidence-based nursing care of a patient treated with the Ilizarov method for lower limb length inequality

Abstract Aim. Presentation of selected elements of nursing care of a patient with lower limb length inequality treated with the Ilizarov method. Material and methods. A patient after surgical placement of an external fixator is presented in this work. An individual case study method was used in this work, whereas the research techniques were: interview, nursing observations, measurements, analysis of nursing records. The research tools included e.g. a guide to collecting patient data and numeric rating scale (NRS) for pain assessment. Nursing diagnoses were made in a traditional way. Results. The study presents nursing interventions based on EBN for 4 diagnoses, e.g.: post-operative wound pain associated with skin incision and deep tissue damage; low mood and sadness due to the perspective of long-term treatment and accompanying disability. Effective improvement of the patient’s health is achieved by implementing nursing care based on scientific evidence. Conclusions. Important aspects of the nursing care of a patient with Ilizarov apparatus include the awareness and knowledge of nursing and clinical problems resulting from skin, soft tissue and bone damage caused by the external fixator. A small number of publications in this field is a motivator to present the topic

Correlation between FLACC scale score and analgesic requirement in children undergoing Minimally Invasive Surgery.

Postoperative pain presents several challenges in pediatric Minimally Invasive Surgery. The Faces, Legs, Activity, Cry, and Consolability (FLACC) scale is a valid scale for pediatric postoperative pain. The aim of our study was to assess postoperative pain using FLACC scale and to analyze the correlation between FLACC scale score and analgesic requirement in children underwent Minimally Invasive Surgery. We retrospectively analyzed data of 153 children aged 2 months-3 years who underwent Minimally Invasive Surgery in our unit from January 2019 and December 2019. Postoperative pain assessment was established using FLACC scale. In each patient were analyzed the correlation between FLACC score and analgesic requirement. Pain evaluation was assigned immediately after surgery and at 15 and 60 minutes. 36.6% of patients (56 children) were asleep so considered pain free; 21.6% of patients (33 children) had a FLACC score more than 7 so they required analgesics and the pain assessment 15 and 60 minutes after was significantly lower. 41.8% of patients (64 children) had a postoperative FLACC score less than 3, so they didn't require any analgesic treatment. On the basis of our results, we recommend FLACC scale for postoperative pain assessment in children underwent MIS aged 2 months-3 years. FLACC scale is an effective and precise scale in detection of postoperative analgesic requirement in children and it could be extended in different age groups with further research.

Nurses’ Assessments Versus Patients’ Self-Assessments of Postoperative Pain: Knowledge and Skills of Nurses for Effective Pain Management

Postoperative pain is the most common form of acute pain. Nurses contribute to effective pain management with their knowledge and skills. The aims of this research were to examine differences between nurses' assessments and patients' self-assessments of postoperative pain, differences in the mentioned (self) assessments with respect to characteristics of both groups of respondents, and the correlation between the NRS and the VRS scale. The study included 103 nurses employed at a hospital and 103 patients treated in the surgical departments after the surgical procedures. Data were collected using the standardized Numerical rating scale (NRS) and Verbal rating score (VRS). The median of patients' self-assessments of pain intensity on the NRS scale was 4, while the nursing assessment of patients' pain was 3, with no significant difference (p = 0.083). No significant differences were found on the VRS scale between nurse assessments and patient self-assessments of current pain intensity. The pain was described as moderate by 35% of participants, including 35.9% nurses and 35% patients. Significant positive correlations were recorded between values on the VRS and NRS scales for nurses (Rho = 0.812; p < 0.001) and patients (Rho = 0.830; p < 0.001). The results of this study may have implications for the improvement of postoperative pain management protocols, with regular use of pain assessment scales and individualization of analgesic prescriptions.

Association between preoperative serum C-reactive protein level and leukocyte count and postoperative pain after otolaryngological surgery

PurposeTo determine whether the preoperative inflammatory serum C-reactive protein (CRP) and leukocyte count (LEUK) are associated with postoperative pain and complaints after otolaryngological surgery.MethodsRetrospective evaluation of 680 patients (33% female, median age 50 years) receiving otolaryngological surgery between November 2008 and March 2017 in a tertiary university hospital. Postoperative pain on the first postoperative day was assessed using the validated questionnaire of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale for assessment of postoperative pain (NRS, 0–10). The influence of preoperative parameters including CRP and LEUK on patients' postoperative pain was estimated.ResultsMean CRP value was 15.6 ± 34.6 mg/l and mean LEUK value 7.8 ± 3.2 Gpt/l. Patients with pharyngeal surgery had the highest CRP values (34.6 ± 52.9 mg/l), highest LEUK values (9.2 ± 4.2 Gpt/l) and the highest pain levels (3.1 ± 2.4 NRS) compared to all other surgical procedures (all p < 0.05). Higher postoperative pain was associated with LEUK values > 11.3 Gpt/l (r = 0.093, p = 0.016) and higher preoperative chronic pain (r = 0.127, p = 0.001). Multivariate analysis confirmed younger age, female gender, duration of surgery, preoperative chronic pain, type of surgery, and higher LEUK values > 11.3 as independent factors for postoperative pain. Perioperative antibiotics had no effect on the postoperative pain.ConclusionBeyond known factors, preoperative LEUK as inflammation marker is an independent predictor for pain on the first postoperative day.

Parents' perceptions of their child's pain assessment in hospital care: A cross-sectional study

PurposeA prerequisite for successful pain management is identifying the pain and assessing its intensity. The aim of this study was to describe parents' perceptions of their child's pain assessment in hospital care. Design and methodsThis study was a descriptive cross-sectional study. A questionnaire was completed by parents (n = 261) whose child was hospitalized in one of the pediatric units (n = 6) of the University Hospital in Finland. Quantitative data were analyzed using statistical methods; open-ended data were analyzed using inductive content analysis. ResultsParents reported that their children experienced moderate (36%) to severe pain (42%) during hospitalization. The most intense pain experienced by the children was associated with needle-related procedures (41%). A large proportion of parents (83%) were involved in their child's pain assessment. Parents were satisfied with their child's pain assessment but perceived some shortcomings. Parents hoped that a variety of methods would be used to assess their child's pain and that the parents' and child's views on pain would be taken into account. ConclusionsMost children experience moderate to severe pain during hospitalization. Parents are often involved in pain assessment but are rarely instructed to use pain scales. Practice implicationsChild's pain should be assessed regularly and frequently enough. It is important that the child and parents are involved in shared decision-making about pain assessment and treatment, and they have opportunities to ask questions. Guidance should be offered to parents about the use of pain assessment scales.

PAIN MANAGEMENT IN POSTOPERATIVE TOTAL KNEE ARTHROPLASTY IN EPIDURAL BUPIVACAINE INJECTION VERSUS INTRA-ARTICULAR INJECTION

Total Knee Arthroplasty (TKA) improves the quality of life of osteoarthritic and rheumatoid arthritis patients, however, is associated with moderate to severe postoperative pain. There are multiple methods of managing postoperative pain that include epidural anesthesia but it prevents early mobilization and results in postoperative hypotension and spinal infection. Controlling local pain pathways through intra-articular administration of analgesics is a novel method and is inexpensive and simple. Hence, we assess the effects of postoperative epidural bupivacaine injection along with intra-articular injection in total knee replacement patients.The methodology included 100 patients undergoing TKA randomly divided into two groups, one administered with only epidural bupivacaine injection and the other with intra-articular cocktail injection. The results were measured based on a 10-point pain assessment scale, knee's range of motion (ROM), and Lysholm knee score.The VAS score was lower in the intra-articular cocktail group compared to the bupivacaine injection group until the end of 1-week post-administration (p&lt;0.01). Among inter-group comparisons, we observed that the range of motion was significantly more in cocktail injection as compared to the bupivacaine group till the end of one week (p&lt;0.05). Lysholm's score was significantly more in cocktail injection as compared to the bupivacaine group till the end of one week (p&lt;0.05).Our study showed that both epidural bupivacaine injection and intra-articular injection were effective in reducing pain after TKA and have a comparable functional outcome at the end of 4 weeks follow up. However, the pain relief was faster in cases with intra-articular injection, providing the opportunity for early rehabilitation. Thus, we recommend the use of intra-articular cocktail injection for postoperative management of pain after total knee arthroplasty, which enables early rehabilitation and faster functional recovery of these patients.

A Systematic Review of the Measurement Properties of Face, Legs, Activity, Cry and Consolability Scale for Pediatric Pain Assessment.

We performed this systematic review to summarize the psychometric properties of Face, Legs, Activity, Cry and Consolability (FLACC) scale in pediatric patients in different settings. Two investigators independently searched PubMed, EMBASE, OVID and China National Knowledge Infrastructure (CNKI) for eligible studies through July 2021. We assessed the psychometric properties using the modified critical appraisal tool (CAT). Finally, we systematically reviewed the results of the included studies. A total of 15 studies were eventually included. The overall quality of each eligible study was low to moderate. The FLACC scale has been available in different versions and in different settings. Although eligible studies have demonstrated significant clinical benefit in assessing postoperative pain in pediatric patients aged 0 to 10 years from post-anesthetic care unit (PACU), pediatric intensive care unit (PICU) and inpatient unit, and in assessing procedural pain in pediatric patients aged 0.5 to 7 years from emergency unit, immunization center and PICU, mostly without test-retest analysis. Although the absence of a gold standard of pain assessment, the currently available data support the usefulness of the FLACC from the perspective of criterion validity. Therefore, the FLACC scale can be considered for measuring observational pain in infants and children. However, further studies are still needed to provide more robust evidence.

Postoperative Pain of Pediatric Patients Undergoing Dental Treatment under General Anesthesia Visiting a General Hospital: A Cross-Sectional Study.

Dental general anesthesia (GA) is a day-stay procedure and is a suitable choice for complicated cases. It is undertaken in a controlled hospital setting that ensures the quality, safety, efficacy, and efficiency of dental treatment. The purpose of this study is to determine the prevalence, severity, duration, and factors related to the occurrence of postoperative discomfort in young children following GA in a general hospital. This study includes a minimum sample size of 23 children that were undergoing GA over a 1-month period. Informed consent was obtained from the parent prior to the treatment. A preoperative questionnaire via the Survey Monkey program was used for the purposes of recording the responses of the survey population. All data related to the immediate postoperative period while the child was in the post-anesthetic recovery room (PAR) was collected and assessed by one of the investigators using the Face, Legs, Activity, Cry, and Consolability (FLACC) pain assessment scale. Postoperative data was gathered using the Dental Discomfort Questionnaire (DDQ-8) and was performed by phone 3 days after the GA procedure. The participating 23 children ranged from 4 to 9 years old (mean 5.43 ± 1.53). A total of 65.2% were girls and 34.8% were boys, with 30.4% experiencing a recent history of pain.

Assessment of thermal response, cardiorespiratory parameters and post-operative analgesia in dogs undergoing ovariohysterectomy with different combinations of epidural analgesia and isoflurane

This study aimed to evaluate the thermal response of the eyelids and lacrimal gland of the left eye (LETG) through infrared thermography (IRT), cardiorespiratory parameters, and their association with nociception and pain in bitches undergoing elective ovariohysterectomy (OVH) anesthetized with isoflurane and epidural analgesia. Twenty-one healthy bitches of different breeds were randomized into three groups receiving epidural blocks: GL (n=7), lidocaine (2 mg Kg-1); GLF (n=7), lidocaine (2 mg Kg-1) and fentanyl (3 µg Kg-1); and GLM (n=7), lidocaine (2 mg Kg-1) with morphine (0.1 mg Kg-1). IRT and cardiorespiratory parameters were evaluated at baseline (Ebasal), thirty minutes before anesthetic premedication, and at different surgical events: first incision (EInc), ligature and section of the left (ELoV), and right (ERoV) ovarian pedicle, ligature, and re-section of the cervix (EUt), and skin suture (ESut). The assessment of acute pain in the immediate post-operative period was registered at E1h, E2h, and E3h using IRT, the Dynamic Interactive Visual Analogic Scale (DIVAS), and the University of Melbourne Pain Scale (UMPS) scales. The results showed a statistically significant decrease in the lower eyelid surface temperature (LELT) during EInc for GL (32.9°C ± 0.62), in comparison to GLF (34.2°C ± 0.62) and GLM (35.3°C ± 0.62) (P = 0.006). Regarding LETG, a significant increase (P = 0.03) in the IRT of Ebasal (36.8°C ± 0.63) and EInc (36.1°C ± 0.63) for GLM was observed in comparison to the thermographic values for both perioperative events and groups. The GLM showed a significant decrease in IRT values of ERoV at E3h in the upper and lower eyelids (P = 0.03 and P = 0.01, respectively). A progressive and significant reduction of the IRT values of LETG was also recorded in GLM, with differences in ERoV (35.2 °C ± 0.63) (P = 0.02) and E3h (35.3 °C ± 0.63) (P = 0.01). The cardiovascular parameters (SAP, DAP, and MAP) did not differ between treatments, but in GL, there was a significant difference (P = 0.01) during EInc and ESut, compared to Ebasal. In the body temperature, EInc and ESut gradually decreased in all treatment groups (P = 0.01). In conclusion, hemodynamic and cardiorespiratory stability was associated with IRT readings and the absence of nociception. Changes in superficial temperature in the immediate post-operative period were lessened using isoflurane and epidural analgesia of lidocaine alone or in combination with pure opioids. These findings were clinically validated to the DIVAS and UMPS acute pain assessment scales.

ALPS-Neo pain and stress assessment scale for neonates-A measure for procedural pain.

The aim of this study was to investigate psychometric properties, reliability and validity, of Astrid Lindgren and Lund Children's Hospitals Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo), as a measure for procedural pain. This observational, prospective study with a repeated measures design, explored inter-rater reliability by two raters assessing 21 neonates during non-pain and pain events. Construct validity was explored, that is, ability to discriminate between non-pain and pain, and criterion validity by correlating ALPS-Neo with Premature Infant Pain Profile-Revised (PIPP-R) and Skin Conductance Algesimeter (SCA) in 54 neonates without ventilator support and sedation undergoing routine heel-stick procedure in a tertiary neonatal intensive care unit. Mean gestational and assessment age of 54 infants was 33.8 weeks and 12.7 days respectively. Inter-rater reliability from baseline, skin wiping, heel-stick events for 21 infants demonstrated intraclass correlations with 95% confidence intervals (CI) of 0.49 (-0.27 to 0.79), 0.86 (0.65-0.94) and 0.73 (0.34-0.89) respectively. ALPS-Neo discriminated significantly between baseline, non-pain and heel-stick (mean differences from pain event -2.3 and -1.0 respectively) and correlated during heel-stick with PIPP-R (r = 0.56, 95% CI: 0.34-0.72), not with SCA. ALPS-Neo may be used as a measure for procedural pain.

Psychometric evaluation of the electronic faces thermometer scale for pain assessment in children 8-17 years old: A study protocol.

It is often a challenge for a child to communicate their pain, and their possibilities to do so should be strengthened in healthcare settings. Digital self-assessment provides a potential solution for person-centered care in pain management and promotes child participation when a child is ill. A child's perception of pain assessment differs when it is assessed using digital or analog formats. As we move into the digital era, there is an urgent need to validate digital pain assessment tools, including the newly developed electronic Faces Thermometer Scale (eFTS). This study protocol describes three studies with the overall aim to evaluate psychometric properties of the eFTS for assessing pain in children 8-17 years of age. A multi-site project design combining quantitative and qualitative methods will be used for three observational studies. Study 1: 100 Swedish-speaking children will report the level of anticipated pain from vignettes describing painful situations in four levels of pain and a think-aloud method will be used for data collection. Data will be analyzed with phenomenography as well as descriptive and comparative statistics. Study 2: 600 children aged 8-17 years at pediatric and dental settings in Sweden, Denmark, Iceland, and USA will be included. Children will assess their pain intensity due to medical or dental procedures, surgery, or acute pain using three different pain Scales for each time point; the eFTS, the Faces Pain Scale Revised, and the Coloured Analogue Scale. Descriptive and comparative statistics will be used, with subanalysis taking cultural context into consideration. Study 3: A subgroup of 20 children out of these 600 children will be purposely included in an interview to describe experiences of grading their own pain using the eFTS. Qualitative data will be analyzed with content analysis. Our pilot studies showed high level of adherence to the study procedure and rendered only a small revision of background questionnaires. Preliminary analysis indicated that the instruments are adequate to be used by children and that the analysis plan is feasible. A digital pain assessment tool contributes to an increase in pain assessment in pediatric care. The Medical Research Council framework for complex interventions in healthcare supports a thorough development of a new scale. By evaluating psychometric properties in several settings by both qualitative and quantitative methods, the eFTS will become a well-validated tool to strengthen the child's voice within healthcare.