Wong-Baker Faces Pain Scale Research Articles

Virtual Reality as Active Distraction in Laceration Repair: A Game Changer?

We conducted an unblinded, randomized control trial to determine if immersive virtual reality (VR) goggles decrease pain and fear scores in children undergoing laceration repair in the pediatric emergency department (PED) compared to the standard of care. Secondary outcomes included duration of procedure, physical holding, anxiolytic usage, and desire to use VR goggles again. Ninety-one patients aged 6-17 years in a PED with simple lacerations sutured by PED staff completed surveys. Eligible patients were randomized to receive either VR or standard of care. Guardians and providers also completed surveys. Self-reported pain scores were assessed by the Wong-Baker Faces Pain Scale and fear scores by Children's Fear Scale. There were significant reductions in pain and fear scores for VR goggles compared to standard of care. Patients rated their mean pain score as 3.7 in controls and 2.3 in the VR group, and mean fear score of 3.0 and 2.2. The likelihood of physical holding was significantly lower among those who used VR goggles (adjusted odds ratio = 0.34, 95% confidence interval [0.13-0.92], P = 0.033). The likelihood of receiving anxiolytics was lower among the 12- to 17-year-olds (adjusted odds ratio = 0.27, 95% confidence interval [0.11-0.69], P = 0.006). There was no significant difference in the procedure duration (P = 0.06). A total of 97.9% of parents, 93.6% of patients, and 95.7% of providers would use VR again. Virtual reality goggles are an effective tool for distraction for simple laceration repairs. Their use leads to decreased pain and fear. Children who used VR goggles did not require to be held as often for sutures. There was no significant difference in anxiolytics or duration of procedure.

Effects of Procedural Information, Buzzy, and Multiple Interventions on Pain in Children Undergoing Venipuncture: A Randomized Controlled Trial.

Needle-related procedures are commonly performed in childhood and lead to considerable pain. This randomized controlled study was conducted to compare the effects on venipuncture pain of the Buzzy, an informational animated video, multiple interventions, and standard care in children aged 6-12 years. One hundred eighty children were assigned to the groups using a computerized randomization program. Pain level was evaluated by the children, parents, and their nurses using the Wong-Baker Faces Pain Scale. The level of agreement among the nurse, parents, and children's pain reports was evaluated. Multivariable regression analysis was performed to identify the factors significantly associated with pain score. The participants in the Buzzy, video watching, and multiple intervention groups reported lower mean pain scores (child: KW = 28.24, p < .001; parent: KW = 18.51, p < .001; nurse: KW = 44.4, p < .001) than their peers in the control group. Moreover, age was identified as a risk factor affecting pain level (OR = 1.375, 95% CI [1.086, 1.740]; p = .008). Buzzy and informational videos are potentially effective methods to facilitate venipuncture-related pain management in children. The use of pain management methods during venipuncture is recommended, especially in children younger than 10 years old.

Efficacy of administering a sugar-free flavor before dental injections on pain perception in children: A split-mouth randomized crossover clinical trial.

Sweet taste administration before dental injections helps to control associated pain in children. To evaluate the efficacy of using a sugar-free flavor on pain perception during dental injections. Children (n = 84) aged 4-9 (mean 6.71 ± 1.55) years who required buccal infiltration bilaterally participated in this split-mouth randomized crossover study. On the test side (flavor visit), infiltration injections were applied after receiving a sugar-free flavor. On the control side (no flavor visit), sterile water was administered. Demographic characteristics, body mass index (BMI), and sweet taste preference (STP) were recorded. Pain perception during injection was measured using heart rate (HR), sound, eyes, and motor (SEM) scale, and Wong-Baker Faces pain scale (WBFPS). Most children had healthy weight (72.6%) and equal STP (32.1%). In the test side, mean HR during injection, HR differences before and during injection, and SEM scores were significantly lower (p < .001, for all). There was no significant difference in the WBFPS between both visits. Flavor had a significant effect on pain reduction (p = .001 for HR, p = .000 for SEM), whereas age, gender, BMI, STP, and treatment side did not. Treatment sequence had a significant effect on total SEM scores (p = .021); children who received the flavor during their first visit had lower SEM scores. Using a sugar-free flavor before dental injections helps in reducing associated pain in children.

USE OF PAIN SCALE IN CHILDREN WITH CHEST PAIN: AN OBSERVATION IN TERMS OF CARDIAC ORIGIN

OBJECTIVE: Chest pain in children and adolescents is usually due to non-cardiac causes. The basic assumption in distinguishing the etiology is the cardiologic evaluation. The relationship between the severity of pain and its cardiologic etiology has not been investigated before. This study aimed to evaluate the pain scale, demographic-laboratory data, electrocardiographic and echocardiographic findings in order to better define pain in children who were admitted to the pediatric cardiology outpatient clinic with chest pain, based on the hypothesis that there is a correlation between chest pain with cardiac origin and pain severity. MATERIAL AND METHODS: This study was carried out with 131 patients in the pediatric cardiology outpatient clinic of the tertiary pediatric hospital. The Wong-Baker Faces Pain Scale was used to inquire about chest pain. RESULTS: 80 girls and 51 boys were included in the study. The mean age of the cases was 13.4±2.9 years. Echocardiographic findings: 87.8% were normal, 12.2% had pathological findings. The most common cardiac pathology was mitral valve regurgitation (4.6%). According to the Wong-Baker Faces pain scale, patients mostly showed 4 points (29%) and 6 points (47.3%) mimics. CONCLUSIONS: Echocardiography has limited diagnostic power in children with chest pain. This study failed to detect any significant relationship between pain scale and cardiac pathology. The evaluation with the Wong-Baker Faces Pain Scale was assessed to be insufficient.

Split-mouth Comparison of Anesthetic Efficacy of Articaine and Lidocaine for Extractions of Deciduous Maxillary Teeth: A Randomized Controlled Trial.

To clinically evaluate whether 4% articaine administered alone as a single buccal infiltration in deciduous maxillary tooth extraction can provide favorable palatal anesthesia compared to buccal and palatal infiltrations using 2% lidocaine. A prospective, double-blind, split-mouth, randomized controlled clinical study was carried out on 60 children comprising 36 females and 24 males in the age group of 5-10 years. During two separate appointments, children randomly received either 4% articaine with 1:1,00,000 epinephrine (group I-experimental) as buccal infiltration alone, or 2% lidocaine with 1:80,000 epinephrine (group II-control) as buccal plus palatal infiltration. Second local anesthetic agent was administered at least 1 week apart from first administration. Efficacy of anesthesia was assessed using subjective [Wong-Baker Faces Pain Scale (WBFPS)] and objective [sound, eye, motor (SEM)] scales along with occurrence of any adverse effects. For infiltration procedure, 4% articaine (group I) had statistically highly significant (p < 0.001) pain scores on WBFPS as well as on SEM scale compared to 2% lidocaine (group II). According to WBFPS (p = 0.43) and SEM (p = 0.32) scores, the pain on extraction between 4% articaine and 2% lidocaine was statistically insignificant. About 4% articaine buccal infiltration showed better clinical anesthetic efficacy, thus providing effective palatal anesthesia due to its enhanced vestibule-palatal diffusion with no significant postanesthetic complications. Hence, articaine can be used as an alternative to lidocaine in children for extractions of deciduous maxillary teeth. Jankar JL, Pustake BJ. Split-mouth Comparison of Anesthetic Efficacy of Articaine and Lidocaine for Extractions of Deciduous Maxillary Teeth: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(S-1):S6-S10.

Virtual reality in the outpatient: reducing anxiety and fear in venous puncture

To analyze whether the use of virtual reality (VR) headsets during venipuncture can modify the perception of pain, anxiety, and fear in pediatrics. Open label, randomized clinical trial. The presence of intellectual, visual, or hearing impairment were considered exclusion criteria. Two anxiety and fear scales were administered before and after the procedure, and the Wong-Baker face pain scale at the end. The following were recorded: number of venipuncture attempts, duration of the procedure, and side effects. 78 patients were included, 38 males and a mean age of 9.63 years. In the intervention group, the mean pain value was 2.87, with a mean difference (MD) of -0.85 compared with the control one (95% confidence interval (CI) -2.02 to 0.33). There was a significant reduction in the level of anxiety and fear, with MDs of -2.59 (95%CI: -3.92 to -1.26) and -0.85 points (95%CI: -1.45 to -0.24), respectively. the use of VR headsets in venipuncture in hospital daytime care decreases the level of anxiety and fear in children and seems to reduce pain, without adverse effects. The venipuncture procedure has the same success rate and does not increase its duration.

The efficacy of photobiomodulation on dental injection pain: a systematic review of randomized clinical trials.

Dental injections are routinely performed and can result in pain and anxiety in patients. This systematic review aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) in dental injections for pain management in patients undergoing dental treatment. Indexed databases, including PubMed, EMBASE, Scopus, ISI Web of Knowledge, and Cochrane Library, were electronically searched without a time limit up to February 2024. A risk of bias evaluation was performed using the Cochrane tool. A preliminary investigation using electronic and manual methods yielded 4,920,881 manuscripts. Based on the eligibility requirements, 13 randomized control trials (RCTs) were included. Self-assessed pain was determined using the visual analog scale, Face, Legs, Activity, Cry, Controllability scale, or Wong-Baker face pain scale. Eight RCTs demonstrated a notable decrease in needle pain in patients undergoing dental needle injections using PBMT. Based on current evidence, PBMT may help reduce needle pain related to dental anesthesia. Further standardized studies are needed to assess the significance of PBMT for postoperative pain in patients undergoing dental injections.

Efficacy of kaleidoscope, virtual reality, and video games to alleviate dental anxiety during local anesthesia in children: a randomized clinical trial.

Distraction is a technique used to divert a patient's attention from unpleasant procedures. This study aimed to evaluate the effectiveness of kaleidoscopy, virtual reality, and video games in reducing anxiety and pain during invasive dental procedures in children. Sixty-six children aged 6 to 9 years were randomly assigned to three groups during local anesthesia administration: Group 1 (kaleidoscope), Group 2 (virtual reality), and Group 3 (mobile video games). The anxiety of the children was evaluated using physiological measures (heart rate) at three different time points: before, during, and after the procedure. The Raghavendra, Madhuri, and Sujata pictorial scale was used as a subjective measure before and after the procedure. Subjective measures of pain were assessed using the Wong-Baker Faces Pain Scale. The data were statistically analyzed using the Kruskal-Wallis and Wilcoxon signed-rank tests. In the intergroup comparison, there were no statistically significant differences in the physiological measures of anxiety scores between the three groups before, during, and after distraction. Raghavendra, Madhuri, and Sujata pictorial scale scores were assessed before and after distraction, but no statistically significant differences were observed. Among the three groups, the children in Group 2 showed a significant reduction in pain scores. Compared with kaleidoscopes and video games, virtual reality is a promising distraction technique for reducing dental fear, anxiety, and pain during local anesthesia administration in children.

Keep Calm: Does parental preoperative anxiety affect post-tonsillectomy pain scores in children?

PurposeTo understand if high parental anxiety leads to increased post-tonsillectomy pain in children.MethodsProspective study including parents of children aged 3–10 years old submitted to tonsillectomy with or without adenoidectomy. To evaluate anxiety, parents were asked to fill the State-Trait Anxiety Inventory form-Y, with postoperative pain being evaluated with the Wong-Baker FACES pain scale at postoperative days 1, 3 and 7. Parents were also asked to register the number of days during which children took analgesic and the number of analgesic intakes needed.Results41 parents were enrolled, of which 95.1% (n = 39) were female with a mean age of 35.64 years (SD 5.751), with 41 children also being enrolled, of which 85.4% of children (n = 35) underwent tonsillectomy and adenoidectomy. 43.9% (n = 18) of parents presented State anxiety scores above the cut-off level and 53.7% (n = 22) above the Trait anxiety scores above the cut-off. Children of parents with high State anxiety presented statistically higher pain scores in both the third (p = 0.035) and the seventh postoperative days (p = 0.006), with significantly longer use of analgesic medication (p = 0.043) being found, as well as a statistically higher number of analgesic intakes (p = 0.045) (Table 4).ConclusionThe present study establishes an association between preoperative parental anxiety, postoperative pain scores and the need for longer analgesic use in children undergoing tonsillectomy. This reinforces the importance of reducing parental anxiety and opens the door for further strategies to better post-tonsillectomy outcomes.

No-anesthesia for Colles fracture

BackgroundThis study aims to measure the perceived pain during the reduction of Colles fracture without anesthesia in both children and adults. It describes the process and reveals duration for reduction, total hospital stays and compares them with the same procedure under hematoma block. MethodsWe employed the Wong-Baker FACES pain scale to assess pain reduction in 135 adults and 98 pediatric patients undergoing Colles fracture reduction with or without hematoma block. We also measured the time required for the reduction and the overall process. ResultsFor fracture reduction without anesthesia, Wong-Baker FACES scores were 9.2 for children and 8.7 for adults. With hematoma block, scores dropped to 7.5 for children and 5.2 for adults with only a 10 min addition to the hospital stay. Pain scores among pediatric patients exhibited moderate to strong negative correlations with age. The reduction maneuver itself took an average of 5 s. ConclusionsThe reduction of a Colles fracture is nearly instantaneous, making the reduction without anesthesia tolerable. Pediatric patients don't benefit from hematoma block as much as adult counterparts. It significantly reduced pain scores by 1.7 points in children and 3.5 points in adults. Level of evidenceLevel I, Randomized Controlled Trial.

Protocol for Surgery or Cast of the EpicoNdyle in Children's Elbows (SCIENCE).

The management of fractures of the medial epicondyle is one of the greatest controversies in paediatric fracture care, with uncertainty concerning the need for surgery. The British Society of Children's Orthopaedic Surgery prioritized this as their most important research question in paediatric trauma. This is the protocol for a randomized controlled, multicentre, prospective superiority trial of operative fixation versus nonoperative treatment for displaced medial epicondyle fractures: the Surgery or Cast of the EpicoNdyle in Children's Elbows (SCIENCE) trial. Children aged seven to 15 years old inclusive, who have sustained a displaced fracture of the medial epicondyle, are eligible to take part. Baseline function using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper limb score, pain measured using the Wong Baker FACES pain scale, and quality of life (QoL) assessed with the EuroQol five-dimension questionnaire for younger patients (EQ-5D-Y) will be collected. Each patient will be randomly allocated (1:1, stratified using a minimization algorithm by centre and initial elbow dislocation status (i.e. dislocated or not-dislocated at presentation to the emergency department)) to either a regimen of the operative fixation or non-surgical treatment. At six weeks, and three, six, and 12 months, data on function, pain, sports/music participation, QoL, immobilization, and analgesia will be collected. These will also be repeated annually until the child reaches the age of 16 years. Four weeks after injury, the main outcomes plus data on complications, resource use, and school absence will be collected. The primary outcome is the PROMIS upper limb score at 12 months post-randomization. All data will be obtained through electronic questionnaires completed by the participants and/or parents/guardians. The NHS number of participants will be stored to enable future data linkage to sources of routinely collected data (i.e. Hospital Episode Statistics).

The Effect of Using Virtual Reality During Burn Dressing on Pain, Anxiety and Fear Felt in Children: A Randomized Controlled Trial.

This study was conducted to determine the effect of using virtual reality (VR) during burn dressing on the level of fear, anxiety, and pain that children would experience. This randomized controlled trial was conducted in a pretest-posttest design. Randomization of the participants (n = 65) was performed with the block randomization method. Then, 33 children were included in the intervention and 32 children in the control group with simple sequential randomization. The study data were collected using the "Family and Child Personal Information Form," "Physiological Parameters Registration Form," "Wong-Baker Faces Pain Scale," "Children's Fear Scale," and "Children's Anxiety Meter-State." The chi-square test, t-test, Shapiro-Wilk, mean, and percentile distributions were used for the data analysis. After dressing, the physiological parameters of the children who used VR were found to be within normal limits (HR: 108.48 ± 12.43, O2: 98.39 ± 1.14) compared to the children who did not use (HR: 117.38 ± 15.25, O2: 97.81 ± 1.35) (P < .05). After the dressing, children using VR (0.85 ± 1.23) were determined to have less fear than those who did not use them (3.03 ± 1.06), and similarly, children who used VR (2.64 ± 2.73) experienced less anxiety than those who did not use them (5.84 ± 2.26). When the pain levels were evaluated, the VR group (1.79 ± 2.04) was reported to feel less pain compared to the control group (5.50 ± 2.36). The VR used by children aged 5-10 years during burn dressing has been found to affect their physiological parameters and is effective in reducing fear, anxiety, and pain levels.

Efficacy of Virtual Reality Distraction in Reduction of Pain and Anxiety of Pediatric Dental Patients in an Iranian Population: A Split-Mouth Randomized Crossover Clinical Trial.

This crossover clinical trial was conducted with eligible 6-8-year-old children requiring bilateral mandibular molar pulpotomy. At the first treatment visit, pulpotomy was performed for 15 children using VR glasses distraction while the other 15 children received a pulpotomy without any VR glasses; this trend was reversed at the second session and pulpotomy was performed for the contralateral tooth. Pulse rate (PR) and Modified Child Dental Anxiety Scale (MCDAS) measured the anxiety levels. Wong-Baker Faces Pain Scale (WBFP) assessed the pain perception before and after the intervention. Data were analyzed by Statistical Package for the Social Sciences version 25 using the Mann-Whitney and χ2 tests. The mean PR was not significantly different between the two groups. However, the test group showed significantly lower scores of MCDAS (P value = 0.02) and WBFP (P value = 0.001) compared with the control group. The present results suggest that VR headsets can decrease the level of pain and anxiety of patients during primary mandibular pulpotomy. This trial is registered with IRCT20200315046782N1.

Transdermal buprenorphine patch as an adjunct to multimodal analgesia after total joint arthroplasty: a retrospective cohort study.

Total hip arthroplasty or total knee arthroplasty (THA/TKA) is often associated with varying degrees of pain. In recent years, transdermal buprenorphine (TDB) patch has shown encouraging results for acute postoperative pain control in orthopedic surgery. The aim of our study was to investigate the efficacy and safety of the combination of TDB patch and nonsteroidal anti-inflammatory drugs (NSAIDs) as a multimodal analgesic regimen after THA/TKA. Patients who underwent THA and TKA between January 2022 and January 2023 were reviewed. Three postoperative analgesic regimens were selected: Group A (flurbiprofen 50mg and tramadol 37.5mg/acetaminophen 325mg), Group B (flurbiprofen 50mg and TDB 5mg), and Group C (Parecoxib 40mg and TDB 5mg). The primary outcomes were the Wong-Baker face pain scale revision (FPS-R) scores and the rate of sleep disturbances. Secondary outcomes of the study included the proportion of patients with postoperative pain relief rates categorized as 0%, <50%, ≥50%, and 100%. The dynamic FPS-R pain scores on day 3 after surgery in Group B were significantly lower than those in Group A for THA (P < 0.017). The dynamic FPS-R pain scores were lowest in Group C on day 2 and 3 after THA and TKA (P < 0.017). Rate of sleep disturbances was significantly lower in Group B for THA and in Group C for TKA, respectively, compared with that in Group A (P < 0.017). The proportion of dynamic pain relief rate ≥50% in Group C was statistically higher than that in Group A for THA (P < 0.017). Rate of adverse reactions among three groups for THA and TKA was not statistically different (P > 0.05). This study suggests that the combination of TDB patch and NSAIDs is safe and effective for postoperative analgesia after THA/TKA.

Effect of Valsalva Maneuver on Pain Perception During Blood Sample Collection Among Patients

Background: Blood sample collection is the most frequent intrusive practise that hurts patients in hospital settings. A non-pharmacological and economical way to lessen pain during blood sample collection is the Valsalva Maneuver. Objectives; The aim of this study was to evaluate the effect of Valsalva Maneuver during blood sample collection. Methods: A quasi-experimental design (post-test only control group design). Self-structured questionnaire on Socio demographic information, clinical parameter and Wong baker face pain scale was used to observe the pain score of participants. The research population includes all the adult patients between the ages of 18 and 50 admitted in IPD. The sample size for the study comprises of 500 Participants who met the inclusion criteria. Purposive sampling technique was used to identify adult patients between the ages of 18 and 50 who were having blood sample collection admitted in IPD in IMS &amp; SUM hospital, Bhubaneswar, Odisha. Results: The results revealed that there is significant reduction in pain during blood sample collection in experimental group with (p=0.000). No association was found between level pain and socio-demographic and clinical parameters. Discussion: The Valsalva manoeuvre is a non-invasive, non-pharmacological, and efficient way to lessen pain related to drawing blood samples. During the collection of blood samples, nurses should demonstrate the Valsalva manoeuvre to patients. In-service education programmes for nurses and students should be included by hospital administration in order to promote the non-pharmacological technique of pain alleviation during blood sample collection.

The Efficacy and Safety of a Combination of Thiocolchicoside and Etoricoxib in Low Back Pain (ESCoTEL): A Randomized Active-Controlled Trial.

Background Low back pain (LBP) is a global health concern. Management of LBP aims at pain relief facilitating improvement of functional ability. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of therapy. However, the selection of NSAIDs is challenging given the range of underlying etiologies and severity. The current study aimed to compare the efficacy and safety of two available fixed-dose combinations (FDCs), namely, a dual FDC (DFC) of etoricoxib (60 mg) and thiocolchicoside (4 mg) versus a triple FDC (TFC) of chlorzoxazone (500 mg), diclofenac (50 mg), and paracetamol (325 mg). Methodology A total of 200 eligible adult subjects aged 18-70 years with a history of LBP and muscle spasm for ≤14 days and Wong-Baker Faces Pain score >4 were enrolled after obtaining written informed consent and randomized in a 1:1 allocation ratio to be treated with either DFC or TFC for 28 days. Efficacy was assessed based on the change in score from baseline (before treatment) to day 28 on the Wong-Baker Faces Pain Scale and the Oswestry Disability Index (ODI) questionnaire, as well as the proportion of subjects who improved upon treatment. Safety was assessed based on adverse events and clinical laboratory test results. Results A significant decrease in pain intensity (p < 0.001) and significant improvement in functional ability (p < 0.001) was observed after treatment with either DFC or TFC. The decrease in Wong-Baker Faces Pain score and ODI, from baseline, was comparable between the treatment groups. However, more subjects with very severe pain at baseline showed ≥30% improvement upon treatment with DFC than with TFC (~25% versus ~12%; p = 0.172). Also, significantly more crippled subjects with very severe functional disability showed improvement in the DFC group compared to the TFC group (~26% versus ~4%; p = 0.008). No adverse events or clinically relevant laboratory test results were evident. Conclusions Both DFC and TFC were comparable in efficacy and safety for the management of recent-onset LBP. However, significantly more subjects with very severe pain or functional disability showed improvement after 28 days when treated with DFC compared to TFC.

Effect of 2% Topical Lidocaine Gel on Discomfort from Electrical Stimulation During Nerve Conduction Studies- A Prospective Double-Blind Placebo-Controlled Study.

Procedure discomfort can limit electrodiagnostic studies. Reducing discomfort can maximize the benefits of these diagnostic tools. This study targeted the discomfort associated with nerve conduction studies (NCS). This was a prospective randomized double-blind placebo-controlled study comparing the effect of topical lidocaine gel (2%) versus analgesic-free lubricant gel (K-Y gel) on pain perception during NCS. Sequential patients (n=130) referred for routine NCS participated in the study. We applied 1 mL of lidocaine gel to one palm, and 1 mL of K-Y gel to the other as a control. After 20-45 min of application, graded increments of electrical stimulation intensity were delivered to record the median and ulnar mixed palmar nerve responses. Patients were then asked to score the degree of pain felt from electrical stimulation over each palm using the Wong-Baker Faces Pain Scale (WBFPS) and the Numeric Rating Scale (NRS), independent of baseline pain. Mean WBFPS and NRS scores for lidocaine-treated palms were significantly lower than those for controls using parametric paired t-test (3.79 vs 4.37 and 3.35 vs 3.78 respectively, all p-values<0.05). Subgroup analysis showed a significant decrease in mean scores in females, patients aged ≤50 years, patients without a history of previous NCS, and patients without comorbidities (all p-values<0.05). Median scores using nonparametric Wilcoxon ranked test also showed statistically significant differences (all p-values<0.05). The results indicate that topical lidocaine 2% gel reduces discomfort associated with NCS. However, despite the statistical significance, clear clinical significance may be lacking. Clinical implementation may be considered for the subgroups that showed the greatest benefit. Further studies that incorporate more efficient drug delivery methods may yield better results.

SuperKid makes it easier: Effect of an intervention prepared with cognitive behavioral technique on reducing fear and pain of children during intravenous insertion

PurposeThe aim of this randomized controlled trial was to evaluate the effectiveness of a cognitive-behavioral SuperKid intervention, in reducing fear and pain among children undergoing intravenous insertion in outpatient services. Design and methodsThis study was designed as a randomized controlled trial, with 96 children aged 5–7 years. SuperKid intervention employed cognitive-behavioral techniques, implemented through a set of prepared cards. Fear was assessed using the Child Fear Scale, while pain status was measured using the Wong Baker Face Pain Scale. Scoring was performed by the mother, child, and researcher. Time series tests were conducted using the Wilks Lambda test. ResultsMost children in both the experimental and control groups reported fear regarding hospital procedures, particularly those involving pain and separation from their mothers. However, children in the experimental group who underwent the SuperKid intervention during and after IV insertion procedure experienced significantly less fear and pain than those in the control group. ConclusionsSuperKid intervention was found to be effective in reducing the procedural fear and pain of children undergoing intravenous insertion in outpatient services. The utilization of cognitive-behavioral techniques through a set of prepared cards provides an accessible and engaging means of alleviating negative emotional experiences among children undergoing medical/nursing procedures. Practice implicationsSuperKid intervention can potentially improve children's attitudes toward medical care and make future procedures easier for them. Healthcare providers could consider incorporating cognitive-behavioral interventions, such as the SuperKid intervention, into their clinical practice to reduce the fear and pain experienced by children during medical/nursing procedures.

Validation of a Novel Radiographic View for Evaluating Proximal Humerus Fractures: The Clear View

Background: Orthogonal radiographs of the proximal humerus are challenging to obtain because the patient's body mass can impede a quality lateral view and positioning of the shoulder can cause fracture displacement and patient discomfort. We describe a novel radiograph, the Clear View, taken 90 degrees to the scapular Y (SY), developed with the goal to minimize pain and reduce radiation exposure. We evaluate the ability to accurately assess proximal humerus fracture displacement utilizing the Clear View in comparison to the standard available x-rays and assess pain score when obtaining the Clear View.Methods: Eleven independent observers at different levels of experience evaluated angulation and translation of three proximal humerus fractures: two cadaveric fractures and a third fracture in a 15-year-old to determine intraobserver correlation (ICC). Each fracture underwent the traditional radiographic series of anteroposterior (AP) in internal rotation (IR), AP in external rotation (ER), true axillary lateral (AX), SY, and transthoracic lateral (TRANS) plus computed tomography (CT). The Clear View was obtained on the two cadaver fractures. Pain scores based on the Wong-Baker FACES Pain Scale were assessed for individual radiographic projections in 13 patients with proximal humerus fractures.Results: ICC was >0.6 for all measures. True fracture angulation was underestimated a majority (>75%) of the time in all radiographic views; TRANS (p<0.001) and AX (p<0.049) views had the least amount of error. Moreover, measures of translation were both underestimated and overestimated in all views, but the most accurate measures of translation were obtained with IR, ER, and Clear Views. Pain scores ranged from 0-1.2 when the Clear View was obtained.Conclusions: Our study demonstrates that proximal humerus fracture angulation is often underestimated, and translation is difficult to measure regardless of view utilized. However, the Clear View, when combined with the AP view, offers an orthogonal, reproducible, valid measure of fracture translation and causes minimal patient discomfort.Level of Evidence: Level II, prospective cohort study Key Concepts•Proximal humerus fracture angulation is often underestimated, and translation is difficult to measure regardless of view utilized.•The newly described Clear View offers a reproducible, valid measure of fracture translation.•The Clear View is associated with low patient discomfort.•The Clear View may also reduce radiation exposure compared to standard transthoracic lateral imaging techniques.•A combination of an AP and the Clear View is recommended as a reproducible and comfortable method to obtain orthogonal views with the ability to measure fracture angulation and translation.

Comparison of Dexmedetomidine with Midazolam as an adjuvant with Propofol for insertion of ProSeal laryngeal mask airway in Children.

Propofol is required in higher doses for smooth insertion of the ProSeal laryngeal mask airway. The ideal adjuvant drug so as to minimise induction doses of propofol is still not known. Dexmedetomidine and midazolam are equally effective for premedication in children. We have designed this study to compare dexmedetomidine and midazolam as adjuvants with propofol for insertion characteristics of ProSeal laryngeal mask airway. A total of 130 paediatric patients undergoing elective surgery were randomly allocated into 2 groups of 65 each. One group was induced using propofol, fentanyl and midazolam, whereas the other group received propofol, fentanyl and dexmedetomidine. Subsequently, insertion characteristics of ProSeal laryngeal mask airway were documented in terms of number of attempts and by using modified Muzi score. Post-operative sedation was recorded by Ramsay Sedation Scale and pain was assessed by using Wong-Baker Faces pain scale. Out of 130 patients, ProSeal laryngeal mask airway was inserted in a second attempt in only 5 patients of midazolam group. Time taken for insertion was significantly higher among the midazolam group (21 seconds) than the dexmedetomidine group (19 seconds). A total of 93.8% of patients administered dexmedetomidine had excellent Muzi scores in comparison to midazolam group where only 13.8% patients had excellent Muzi scores (P < .001). Dexmedetomidine in a dose of 1 μg kg-1 as compared to midazolam (20 μg kg-1) produces better insertion characteristics for ProSeal laryngeal mask airway when used as adjuvant with propofol in terms of jaw opening, ease of insertion, coughing, gagging, patient movement, and laryngospasm.