Wong-Baker Faces Pain Rating Scale Research Articles

Comparative Evaluation of the Efficiency of Polymer Bur, Cera Bur, and Tungsten Carbide Bur in Dentin Caries Excavation of Mandibular Primary Molars: An In vivo Study

ABSTRACT Conservative caries removal has become an integral part of minimally invasive dentistry (MID). Polymer and Cera burs are two feasible MID methods. The aim of the study was to compare the efficiency of Polymer, Cera, and Tungsten carbide bur in dentin caries excavation of mandibular primary molars. 45 children in the age group of 6-8 years with dentin caries, not involving pulp in the second mandibular primary molars, were selected for the study. The three burs compared were polymer bur, Cera bur, and Tungsten Carbide bur. The excavation of carious lesion was performed with each burs using a slow-speed handpiece with 500-1000rpm. Caries removal efficiency was evaluated using the Visual-Tactile method and confirmed Dye detection method. The time taken to complete the caries removal was measured using a stopwatch. The patient’s pain perception was assessed using the Wong–Baker Faces Pain Rating Scale. The intergroup comparisons based on time, dye, and Wong-Baker Faces Pain Rating Scale (WBFPRS) were arrived at using Mann–Whitney and Fisher Exact tests at P < 0.0001. A statistical significance between the three groups on the time taken for caries removal at P < 0.0001. No statistical significance was observed between the three groups for caries removal efficiency and pain perception using the dye and WBFPRS scores at P > 0.001. Cera burs had shown high caries removal efficiency, which had taken less time in the excavation, with reduced pain perception followed by Tungsten Carbide bur and the polymer bur in mandibular primary molars.

Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years.

Local anesthetics are used to alleviate pain, but the prick of the injection delivering anesthesia is known to cause anxiety and pain that affect dental treatment. The most difficult aspect of pediatric dentistry is minimizing discomfort while the intraoral local anesthetic is administered. This pain has been treated using physical, psychological, pharmacological, and combinations of these approaches. Recently, the idea of vibration, which is based on the gates control theory, has gained popularity as a way to reduce discomfort while local anesthesia (LA) is being administered. The aim of this trial was to evaluate the efficacy of mucosal vibrators in children aged 6-10 years to alleviate pain associated with LA administration. A total of 60 patients aged 6-10 years requiring inferior alveolar nerve block were enrolled for this randomized, single-blind clinical trial. In group I, before and during LA administration, the customized mucosal vibrator was placed at the injection site. In group II, the topical local anesthetic gel was applied to the injection site prior to the administration of LA. Then, the local anesthetic solution was deposited using a disposable syringe needle on both groups. The pain was evaluated using the physiological scale (pulse rate and oxygen saturation), the subjective scale (Wong-Baker scale), and the objective scale [Face, Legs, Activity, Cry, Consolability (FLACC) scale] by an experienced assistant who was unaware of the procedure. A customized mucosal vibrator along with local anesthetic injections resulted in significantly less pain (p = 0.001*) when compared with the injections with topical anesthetic gel. The results show that the customized mucosal vibrator is an effective and inexpensive means to reduce pain during LA administration. Tatiya N, Singh C, Surana P, et al. Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years. Int J Clin Pediatr Dent 2024;17(4):404-409.

Effectiveness of erector spinae plane block in children with pectus excavatum deformity during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex: a prospective randomized comparative study

BACKGROUND: Despite the widespread use of regional blocks in children, ensuring adequate perioperative pain control during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex remains a problem. The introduction of ultrasound navigation has allowed specialists to increasingly give preference to peripheral blockades; paravertebral anesthesia has proven to be effective in thoracic surgery. However, safer interfascial blocks, including erector spinae plane block, are rarely used in pediatrics, and there is no evidence base for the effectiveness of the method. OBJECTIVE: Our aim was to compare the effectiveness of erector spinae plane block with paravertebral blockade during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex in children. MATERIALS AND METHODS: A prospective randomized comparative study of children who underwent minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex was conducted from September 2022 to April 2023. According to the inclusion criteria, the selected 39 children were divided into groups: I — paravertebral blockade, and II — erector spinae plane block. The mean arterial pressure, heart rate during the perioperative period stages, postanesthesia recovery by Aldrete scale and pain intensity by the Wong–Baker scale, and stress response markers (cortisol and lactate) were assessed. RESULTS: No significant differences were observed in the study groups when comparing mean arterial pressure and heart rate at any of the measurement points of the perioperative period (p 0.05). Further, no significant differences were noted between the groups when comparing cortisol and lactate levels (p 0.05). The awakening level was characterized by a short recovery period and did not differ between the groups (p 0.05). The intensity of pain during the observation period did not exceed 5 points on the verbal rating scale in both groups, and the severity of pain was significantly higher in the group with blockade of the erector spinae plane block only 2 hours after surgery (p 0.05).Postoperative nausea and vomiting were more common in children with erector spinae plane block (p 0.05). No other adverse events were recorded. CONCLUSION: Erector spinae plane block is an effective and simple method of regional anesthesia for minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex and can be used as an alternative to paravertebral blockade in children.

The Effect of Murottal and Lavender Aromatherapy on Post-Circumition Pain in Pediatric Patients at Oerip Putra Brebes Clinic

Background: Circumcision is a medical procedure involving the removal of the prepuce, resulting in wound and significant postoperative pain that disrupts daily activities. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain has associated side effects, prompting the exploration of non-pharmacological therapies such as murottal and aromatherapy as alternatives for pain management in post-circumcision pediatric patients. Method: This quantitative study utilized a pre-experimental design with a one-group pre-and-post-test approach. A sample of 20 respondents was selected using non-probability purposive sampling at Oerip Putra Brebes Clinic. Pain level was measured using the Wong-Baker Faces Pain Rating Scale. The respondents were being asked three times for the pain scale before the intervention, to make sure the pain scale is not temporarily but it’s their final answer. Data analysis employed the Wilcoxon Signed Rank Test. Data collection was condcuted between December 2022 and February 2023. Results: The average pain scale value before intervention was 4,20, and after intervention, it was 4,70. The Wilcoxon test yielded a p-value of 0,197, indicating no significant impact from murottal and lavender aromatherapy on post-circumcision pediatric patients. Conclusion: The administration of murottal and lavender aromatherapy did not yield a significant impact on post-circumcision pain in pediatric patients.

The use of DryShield versus rubber dam isolation systems among pediatric patients with different airway patency: A randomized clinical trial

ObjectivesThis randomized clinical trial aimed to evaluate the impact of DryShield isolation (DSI) and rubber dam isolation (RDI) system usage on vital signs, behavior, pain and discomfort, and chairside time required among children with different airway patencies based on the Modified Mallampati Classification (MMC). Material and methodsHealthy, cooperative children who required fissure sealant in at least two contralateral, fully erupted, permanent first molars were included. Airway patency was determined by two trained and calibrated dentists using the MMC. The participants were categorized based on their MMC scores into patent airways (classes I and II) and non-patent airways (classes III and IV). The dental procedure was videotaped during treatment, and vital signs, including arterial oxygen saturation, heart rate, and blood pressure, were recorded every 3 min. The participants’ subjective pain and discomfort were evaluated using a previously validated Arabic interview questionnaire and a validated Arabic version of the Wong–Baker Faces Pain Rating Scale. The participants’ behavior and behavioral pain were evaluated utilizing the Frankl Behavior Scale and the face, legs, activity, cry, and consolability scales, respectively. ResultsThere were no significant differences in any of the vital signs between DSI and RDI. DSI use yielded a significant reduction in chairside time (P < 0.001) and was more bothersome (P < 0.001) than RDI use among all participants, regardless of airway patency. DSI was associated with significantly better behavior during the dental procedure (P = 0.002) and less behavioral pain (P < 0.001) among all participants, regardless of airway patency. ConclusionIrrespective of airway patency, DSI outperformed RDI in terms of behavior, pain, and procedure duration; however, DSI was characterized by noise, pressure on soft tissues, and an increased tendency to induce gag reflexes.

Postoperative pain and pain management following selective dorsal rhizotomy

BackgroundSelective dorsal rhizotomy (SDR) is a neurosurgical procedure that reduces lower limb spasticity, performed in some children with spastic diplegic cerebral palsy. Effective pain management after SDR is essential for...

Is it possible to extract primary maxillary molars without palatal injection?: a controlled clinical trial

ObjectivesThe absolute necessity of a palatal injection for the extraction of primary maxillary molars has never been explored, despite the fact that it is widely known that children do not tolerate local anesthetic injections into the palatal tissue well. The aim of this study was to compare separately the perception of pain in the absence of palatal injection after anesthesia and maxillary primary molar tooth extraction using different anesthetic solutions and different post-anesthetic waiting times.Materials and methodsA single-blinded randomized controlled study was conducted in 78 participants (26 patients with palatal anesthesia (the control groups), and 26 patients with 5 min and 26 patients with 8 min post-anesthetic waiting time without palatal anesthesia (the study groups)). Subjective experiences of pain were evaluated separately after anesthesia and tooth extraction using the Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (WBS).ResultsIn terms of VAS scores obtained following administration of anesthesia, there was a statistically significant difference between the groups (p<0.05). VAS pain scores were reported to be lower in the groups without palatal anesthesia than in the groups with palatal anesthesia. No statistically significant difference was observed in VAS and Wong-Baker scores after tooth extraction between the groups with and without palatal anesthesia (P>0.05).ConclusionsWhile the pain reported following administration of anesthesia was found to be higher in the groups receiving palatal anesthesia, no difference was found between the groups in the pain reported after tooth extraction.Clinical relevanceExtraction of maxillary primary molars is possible without palatal injection by injecting 4% articaine or 2% lidocaine into the buccal vestibule of the tooth with a waiting time of 5 or 8 min.

Low-level Laser Therapy to Alleviate Pain of Local Anesthesia Injection in Children: A Randomized Control Trial.

The aim of our study was to evaluate and compare pain perception following photobiomodulation (PBM), topical anesthesia, precooling of the injection site, and vibration during administration of local anesthesia injection in pediatric patients aged 6-13 years. In this split-mouth study, a total of 120 patients between the age group of 6 and 13 years were selected and randomly divided into three equal groups with 40 subjects in each. Pain was assessed using visual analog scale (VAS) and the Wong-Baker Faces Pain Rating Scale after the administration of local anesthesia. Behavior during the procedure was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale filled by the operator. Pulse rate was recorded before and during the administration of local anesthesia using pulse oximeter. After the procedure, patient compliance was also recorded using validated questionnaire. The level of significance was set at p < 0.05. The study showed PBM exhibited the lowest mean scores of anxiety/pain using VAS, Wong-Baker Faces Pain Rating Scale, FLACC scale and pulse rate as compared to precooling, vibration, and topical anesthesia. The differences in pain scores recorded were found to be statistically significant. Children were not anxious about the PBM method and exhibited good compliance (p < 0.001). Photobiomodulation (PBM) was found to be effective means of reducing injection pain, demonstrating much better efficacy than other tested methods. Photobiomodulation (PBM) can be used effectively to better manage procedures that patients frequently find painful without the need for prescription drugs, which frequently have several side effects. Khan BS, Setty JV, Srinivasan I, et al. Low-level Laser Therapy to Alleviate Pain of Local Anesthesia Injection in Children: A Randomized Control Trial. Int J Clin Pediatr Dent 2023;16(S-3):S283-S287.

Impact of Child-Friendly Nursing on Reducing Anxiety, Fear, and Pain in Paediatric Circumcision: A Retrospective Study.

Paediatric circumcision is a standard surgical procedure that frequently induces anxiety, fear, and pain in young patients. Child-friendly nursing has shown potential in alleviating psychosocial distress in paediatric care settings. However, its specific impact on patients undergoing circumcision remains underexplored. This study aimed to evaluate the effectiveness of child-friendly nursing in reducing patients' anxiety, fear and pain in patients undergoing paediatric circumcision. Clinical data of paediatric patients who underwent circumcision at Taizhou Hospital of Zhejiang Province from January 2022 to November 2023 were retrospectively analysed. Patients were divided into the traditional nursing (January 2022 to December 2022) and child-friendly nursing (January 2023 to November 2023) groups. Psychosocial parameters, including anxiety, depression, pain, and fear, were assessed using the Children's Anxiety Meter-State (CAM-S), Children's Depression Inventory (CDI), Wong-Baker FACES Pain Rating Scale (WBFPRS), and Children's Fear Scale (CFS), respectively. No significant differences were found in CAM-S, CDI, WBFPRS, and CFS scores between the two groups before intervention (p > 0.05). However, post-intervention scores for all parameters in the child-friendly nursing group were significantly lower than those in the traditional nursing group (p < 0.001). The results suggest that child-friendly nursing effectively reduces anxiety, depression, fear and pain in children undergoing circumcision. This study provides compelling evidence supporting the effectiveness of child-friendly nursing in enhancing surgical experiences and improving psychosocial outcomes for paediatric patients undergoing circumcision.

Efficacy of sucrose application in minimizing pain perception related to dental injection in children aged 3 to 9 years: a randomized control trial.

Dental fear and anxiety are significant challenges in managing behavior in children. Oral administration of sucrose or sweet-tasting solutions has shown effectiveness in reducing procedural pain in infants and neonates. This study aimed to investigate whether pre-application of sucrose solution had an effect on minimizing pain perception during injection and to assess the potential impact of the child's age and sweet preference. A randomized control clinical trial was conducted on 60 children aged 3-9 years requiring buccal infiltration injections. Following parental consent, demographic data of the children were recorded. Sweet preferences was assessed using a modified forced-choice test. Children were equally and randomly allocated into study (sucrose) and control groups using a lottery method. Sucrose solution or distilled water, respectively, was applied to the lateral surface of the tongue for 2 min. Topical anesthetic was applied at the site of injection, followed by local anesthesia administration. The children rinsed their mouths thrice with water immediately after anesthetic injection. A video was recorded during injection which was then scored by three blinded examiners on the Sound Eye Motor (SEM) scale. The children also self-evaluated using Wong-Baker Faces Pain Rating Scale (WBFPS). The mean SEM scores and WBFPS scores were analyzed using the Kruskall-Wallis test. The mean SEM score in the study group was 1.37 ± 0.61, compared to 3.17 ± 0.87 in the control group, showing a statistically significant difference (P < 0.001). Mean pain scores assessed by WBFPS in the study group were 0.60 ± 1.4, while in the control group, they were 6.27 ± 2.33, also showing a statistically significant difference (P < 0.001). Children with a sweet preference demonstrated a subjective reduction in pain perception. Application of sucrose before dental injections in children helps to minimize pain upon injection across all age groups.

Assessment of Perception of Pain with E-Speed Film, CCD Sensor and Photostimulable Phosphor Plates for Intraoral Radiographs in Children using Three Pain Rating Scales

Abstract Background: Dental radiography is an integral part of intraoral evaluation. Children are often uncomfortable during the placement of film or sensor due to the impingement of the soft tissues. Thus, the perception of pain with three intraoral radiographic methods in children was evaluated using three subjective pain rating scales. Aim: To evaluate the discomfort with three different techniques, that is, intraoral periapical (IOPA) radiograph, charge-coupled device (CCD), and photostimulable phosphor (PSP) luminescence (PSPL), using the Wong–Baker Faces Pain Rating Scale (WBFPRS), numerical rating scale, and visual analog scale (VAS). Materials and Methods: A sample of 35 children aged 6–12 years were divided into two groups: group 1 (6–8 years) and group 2 (9–12 years). For each child, simulations of the three radiological methods (IOPA, CCD, and PSPL) were performed. The meaning of each facial expression on the WBFPRS, VAS, and the numbers on the numerical rating scale was explained to each child before the procedure. Statistical Analysis Used: A one-way analysis of variance (ANOVA) test and paired-samples t-test are used. Results: The results revealed that the CCD sensors elicited higher pain scores than those obtained with IOPA and PSPL, whereas the IOPA film showed the least pain score. Higher score values were obtained in group 1 than in group 2, indicating that children aged 6–8 years felt higher discomfort than the 9- to 12-year age group for the same procedure. This difference was statistically significant (P &lt; 0.001). Conclusion: It was concluded that conventional IOPA films were tolerated better by children when compared to PSP plates and CCD sensors.

Children Anxiety and Pain while Performing Interim Therapeutic Restorations with Hand Instruments compared to Rotary Instruments: A Randomised Clinical Trial

Introduction: Children with dental anxiety may avoid visiting the dentist until a more serious and painful condition develops. Dentists could use less stressful techniques, like Interim Therapeutic Restorations (ITR), to treat dental cavities in difficult or young patients. ITR performed with hand tools may be preferred due to the absence of handpiece vibration, sound, or smell. Aim: To assess the anxiety and pain levels experienced by children during ITR procedures performed with hand instruments compared to rotary instruments. Materials and Methods: The present randomised clinical trial was conducted in the Department of Pediatric Dentistry at King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. The inclusion criteria consisted of children aged 3-12 years visiting the dental clinic for the first time and having a carious primary anterior (incisor or canine) tooth. Patients were recruited from the paediatric screening clinic and randomly assigned to either the “Hand instrument group” or the “Rotary instrument group.” Caries excavation was performed using a hand instrument in the former group, while a low-speed handpiece was used in the latter group. Anxiety levels were assessed using Venham’s anxiety rating scale before and after the procedure. Heart rate was measured using pulse oximetry every two minutes. Pain levels were evaluated using the Wong-Baker Faces Pain Rating Scale after completing the procedure. Results: The study included 60 patients, with a mean age of 5.87±2.09 years. The anxiety score after the procedure was significantly lower in the hand instrument group compared to the rotary instrument group (p=0.007). Although the heart rate was lower in the hand instrument group compared to the rotary instrument group, the difference was not statistically significant. The subjects in the hand instrument group reported lower pain levels compared to those in the rotary instrument group (p=0.029). Conclusion: Performing ITR using hand instruments resulted in reduced anxiety and pain levels among young children compared to ITR performed using rotary handpieces.

Comparison of the therapeutic efficacy of hip arthroplasty and proximal femoral nail antirotation internal fixation for unstable intertrochanteric femur fractures.

To compare the therapeutic efficacy of total hip arthroplasty (THA) versus proximal femoral nail antirotation (PFNA) internal fixation for treating unstable intertrochanteric femur fractures (UIFF). In this retrospective study, the clinical data of 86 patients with intertrochanteric femur fractures (IFF) treated in Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from January 2022 to December 2023 were collected and analyzed. Patients were categorized into two groups based on their treatment modality: the THA group (n=45, treated with THA) and the PFNA group (n=41, treated with PFNA internal fixation). The two groups were compared in terms of surgery-related indicators (operative time, incision length, intraoperative blood loss, postoperative drainage volume, and intraoperative fluoroscopy frequency), postoperative recovery indicators (time to first ambulation, length of stay, time until full weight-bearing ambulation), and the incidence of postoperative complications. The pain indicators (Wong-Baker Faces Pain Rating Scale) and hip joint function indicators (Harris Hip Scores) of patients in the two groups were assessed preoperatively and at 1, 3, and 6 months postoperatively. The hip joint function recovery outcomes of the two groups of patients were recorded at the last follow-up. The PFNA group had significantly shorter operative time, shorter incision length, lower intraoperative blood loss, lower postoperative drainage volume, and higher intraoperative fluoroscopy frequency compared to the THA group (all P < 0.05). The PFNA group also had significantly longer time to first ambulation, length of stay, and time until full weight-bearing ambulation (all P < 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Postoperative Wong-Baker scores in both groups decreased compared to preoperative levels. At 1 and 3 months postoperatively, the PFNA group had significantly higher Wong-Baker scores than the THA group (P < 0.05), but at 6 months postoperatively, the difference was not statistically significant (P > 0.05). Postoperative Harris scores increased in both groups compared to preoperative scores. At 1 month postoperatively, the PFNA group had significantly lower Harris scores than the THA group (P < 0.05); however, at 3 and 6 months postoperatively, the differences were not statistically significant (all P > 0.05). There was no significant difference in the rates of excellent recovery of hip joint function between the two groups at the last follow-up (P > 0.05). Both THA and PFNA internal fixation yield favorable outcomes in treating IFF with no significant difference in complications. The difference lies in the shorter operative time and lesser trauma inflicted by PFNA internal fixation, despite it involving prolonged radiation exposure and bed rest. Conversely, THA requires longer operative time and causes greater trauma but results in shorter postoperative recovery periods, allowing earlier ambulation.

Evaluation of the onset of pulpal, soft tissue anesthesia, and pain using buffered lidocaine in children: a randomized-controlled trial

The American Academy of Paediatric Dentistry (AAPD) has recently released guidelines that highlight the importance of conducting further research on the effects of buffered local anesthesia in children. Adjusting the pH of local anesthetics may reduce pain and reduce the onset time of anaesthesia. In this study, we evaluated the onset of pulpal, soft tissue anesthesia and pain during inferior alveolar nerve block injection to treat pulpally involved mandibular primary molars with buffered lidocaine in comparison with non-buffered lidocaine. We conducted a prospective, randomized, triple-blind, crossover trial involving 40 children aged 7 to 10 years. The onset time of soft tissue anaesthesia was assessed by probing the gingiva after ensuring numbness of the tongue, the lower lip, and the angle of the mouth, while the onset time for pulpal anaesthesia assessed using Endo-ice. We identified a significant difference between buffered lidocaine and non-buffered lidocaine in the onset time of pulpal and soft tissue anesthesia (p &lt; 0.001). Analysis also identified a showed a significant difference between the two groups for the Wong-Baker Faces pain rating scale (p &lt; 0.006) and the Sound, Eye and Motor scale (p &lt; 0.043). In conclusion, buffered lidocaine reduced the onset time for anaesthesia in pulpal and soft tissue, and reduced pain during the administration of inferior alveolar nerve block injections in children. According to the findings of this study, buffered lidocaine can be utilized as an alternative to non-buffered lidocaine in children.

Effectiveness of External Precooling and Vibration Induced by BUZZY on Pain and Anxiety During Inferior Alveolar Nerve Block Injection in Children.

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.

Is the psoas compartment block effective in eliminating pain in children after hip surgery?

BACKGROUND: Hip joint surgery is a highly traumatic surgical intervention. Currently, the anesthesia service in the clinic of H. Turner National Medical Research Center uses either prolonged epidural block with catheter placement in the lumbar spine at the LIII–LIV level or prolonged intravenous analgesia as the main method of pain syndrome treatment after hip joint surgery. Moreover, the potential of prolonged psoas compartment block has not been considered until recently.&#x0D; AIM: To evaluate the effectiveness of prolonged psoas compartment block for pain control in the early postoperative period after hip surgery in comparison with traditional methods of pain control.&#x0D; MATERIALS AND METHODS: This study analyzed the results of postoperative analgesia in 14 children after 15 surgeries in the hip joint, including 3 patients with prolonged psoas compartment block, 9 with prolonged epidural block, and 3 who received postoperative analgesia with systemic analgesics. One patient with bilateral congenital hip joint dislocation was anesthetized with prolonged psoas compartment block after the first operation for the first time and with prolonged epidural block after the second similar operation but on the other leg for the second time. Analgesia efficacy was assessed using the Wong–Baker scale, FLACC behavioral scale, and visual analog scale.&#x0D; RESULTS: All three patients with prolonged psoas compartment block required an addition of butorphanol tartrate (tramal) for good analgesia. Additional administration of opioid analgesics was not needed when a prolonged epidural block was initiated.&#x0D; CONCLUSIONS: Due to the continued need for additional administration of butorphanol tartrate, when prolonged epidural block was available, the use of prolonged psoas compartment block in children for pain relief in the early postoperative period after hip surgery was not considered appropriate.

The effect of sequential dental visits on dental anxiety levels of paediatric patients.

The aim of the present study is to evaluate the relationship between sequential visits in dental caries treatments and dental anxiety levels of paediatric patients through the use of anxiety scales and physiological measurements. A total of 224 children aged 5-8 years who needed at least two bilateral restorative dental caries treatments of the mandibular first primary molar was included in the study. The treatment duration was approximately 20 minutes and time span between the two appointments was a maximum of two weeks. The Wong-Baker FACES Pain Rating Scale (WBFPS) and The Modified Dental Anxiety Scale (MDAS) were used for subjective measurements and the objective measurement of dental anxiety was performed by measuring the heart rate using a portable pulse oximeter. Statistical analysis was carried out using the Statistical Package for the Social Sciences version 22 (IBM corp. Armonk, NY, USA). Out of the 224 children, 117 were girls (mean age 6.4 ± 1.1 years) and 107 were boys (mean age 6.1 ± 1.2 years). The mean age of the patients was 6.26 ± 1.147 years, ranging from 5 to 8. There were no statistical significant differences between children’s age and genders with dental anxiety. However, there were statistical significant differences for the variables regarding the sequential visits. When comparing the MDAS scores statistically significant differences were observed between the first and second visits (p<0.001). Both preoperative and postoperative WBFPS scores were significantly higher at the first visit than at the second visit. Statistically significant differences were observed in the heart rate scores between the treatment sessions (p<0.001). The results of this study show a significant reduction in dental anxiety after sequental dental visits in children aged 5-8 years, which highlights the importance of the sequental visits in paediatric dentistry.

The effect of vibrating cold application and puppet use on pain and fear during phlebotomy in children: A randomized controlled study

BackgroundNon-pharmacological methods are often used as a creative strategy to reduce pain and fear in children during a painful procedure such as phlebotomy. ObjectivesThis study was conducted to evaluate the effects of Bee Buzzy and puppet use on pain and fear during phlebotomy in children. MethodsThis randomized controlled study was conducted in the pediatric phlebotomy unit of a university hospital. The CONSORT checklist was used in this study. The sample of 3–6 years children (n = 105) was divided into groups by block randomization. Children's pain and fear scores were evaluated with the Wong-Baker Faces Pain Rating Scale and Children's Fear Scale by the parents and the nurse who attempted phlebotomy during phlebotomy. ResultsA statistically significant difference was found between the Bee Buzzy and puppet and Bee Buzzy and control groups in pain scores (p < .05). Pain scores were lower in the Bee Buzzy group than in the puppet and control groups. A statistical difference was found between Bee Buzzy and the control group or puppet and control group according to all fear scores (p < .05). Fear scores were lower in the Bee Buzzy and puppet group (p < .05). ConclusionsThe results show that the use of Bee Buzzy during phlebotomy has a pain-relieving effect, and the use of Bee Buzzy and puppet has an anti-fear effect in 3–6-year-old children. Implications for practicesThe use of Bee-Buzzy and puppets is effective in reducing pain and fear in children as they increase effective communication and distract attention.Clinical Trial Registration: National Institutes of Health (NIH), ClinicalTrials.gov, NCT05827783.

Implementation feasibility of animal-assisted therapy in a pediatric intensive care unit: effectiveness on reduction of pain, fear, and anxiety

Animal-assisted therapies are an innovative strategy within health care humanization initiatives, and they could play a role in the reduction of pain or anxiety. The main objective of this work was to evaluate the feasibility of implementing animal-assisted therapy in a pediatric intensive care unit and its effectiveness for the reduction of pain, fear, and anxiety. A prospective, quasi-experimental study of animal-assisted therapy was designed in the pediatric intensive care unit of the Hospital Universitario 12 de Octubre of Madrid, from January 2019 to December 2019. The study sample included patients who had been admitted to the unit and were over 3 years old. Satisfaction surveys were collected from the patients, family, and health personnel involved. Physiological variables and the level of pain (visual analog scale or Wong-Baker scale), fear (Child Medical Fear Scale), and anxiety (modified Yale Preoperatory Anxiety Scale) were evaluated before and after each session. Any existence of adverse events was recorded. A total of 74 therapy sessions were performed on 61 patients. All sessions were completed without any adverse effects. A total of 164 surveys were collected, providing an overall project rating of 9.69 out of a possible 10. The survey comments were found to be positive in most cases. No differences were found in the physiological variables measured before and after each session. There was a statistically significant decrease in pain, fear, and anxiety levels (p < 0.01). Conclusion: The implementation of an animal-assisted therapy project in a pediatric intensive care unit is feasible and safe and has a high degree of acceptance among both participants and healthcare staff. Animal-assisted therapy is effective for the reduction of pain, fear, and anxiety, and therefore, it could be considered an adjunct to non-pharmacological therapy.What is Known:• Animal assisted therapies (AAT) are an innovative strategy that could be beneficial to help pediatrics patients cope with admission difficulties and could even play a role in reducing pain, anxiety and/or delirium.• To date there are not studies to analyze the effectiveness of AAT in the field of Pediatric Intesive Care.What is New:• Our study confirms the feasibility and effectiveness of the implementation of an AAT in the field of Pediatric Intensive Care with a high degree of acceptance by participants, caregivers and healthcare personnel.• AAT demonstrated a reduction in pain, fear and anxiety in pediatrics patients admitted to Pediatric Intensive Care Unit.

Evaluation of Socket Preservation Using Collagen Plug and Injectable Platelet Rich Fibrin in Extracted Sockets of Mandibular Molars: A Split Mouth Study

Aim and Objectives: Evaluation of socket preservation using collagen plug and injectable platelet rich fibrin in extracted sockets of mandibular molars. To evaluate wound healing and bone density using collagen plug and I-PRF and to compare wound healing and bone density between collagen plug and I-PRF. Methodology: This experimental study involves 13 healthy patients at the Sibar Institute of Dental Sciences and Hospital in Guntur, Andhra Pradesh, India, who underwent mandibular molar extraction under local anesthesia. Patients underwent clinical and radio-graphic examinations and received periodontal treatment. The study involved extraction of right and left mandibular molar teeth, AbGel placement, collagen plug placement, and sockets secured with sutures and pressure packs. Postoperative pain, swelling, and wound healing were assessed using Wong-Baker faces pain rating scale, VAS scale, and LANDRY healing index. CBCT was obtained after 1 month and 3 months after extraction for bone quality assessment. Results: In the study, there were 69.2% men and 30.8% women. According to the study, 14.3% of individuals in the collagen plug group and 85.7% of those who received injectable platelet-rich fibrin experienced very good wound healing. On the first and seventh days, the mean pain intensity was lower in the injectable group, but there was not a noticeable distinction between the groups. The injectable group had the lowest swelling score, but by day seven, it had dramatically decreased. At the third month, the collagen plug group had the highest bone density readings, with no discernible difference between the groups. Conclusion: It can be concluded that I-PRF can be utilized as an alternative to collagen plug.