Children

Research

10 pages, 249 KiB

Open AccessArticle

Sedoanalgesia in the Debridement of Pediatric Burns in the Emergency Department: Is It Effective and Safe?

by Carlos Delgado-Miguel, Miriam Miguel-Ferrero, Andrea Ezquerra, Mercedes Díaz, María De Ceano-Vivas and Juan Carlos López-Gutiérrez

Children 2023, 10(7), 1137; https://doi.org/10.3390/children10071137 - 30 Jun 2023

Cited by 1 | Viewed by 988

Abstract

Background: The routine use of sedoanalgesia has increased the number of potential minor surgical procedures that can be performed in the Emergency Department (ED) without requiring general anesthesia and, thus, hospital admission. Our aim is to analyze the effectiveness and safety of the [...] Read more.

Background: The routine use of sedoanalgesia has increased the number of potential minor surgical procedures that can be performed in the Emergency Department (ED) without requiring general anesthesia and, thus, hospital admission. Our aim is to analyze the effectiveness and safety of the use of sedoanalgesia in childhood burns treated in the ED. Methods: A retrospective study was conducted in burned children in whom burn debridement was performed under sedoanalgesia in the ED between 2017 and 2021 in a tertiary referral center for burns. We collected demographic variables, burn features and the type of sedoanalgesia performed in each case, including its effectiveness and associated adverse effects. Results: A total of 227 patients (118 males, 109 females) were included, with a median age of 25 months. In total, 99.2% of the burns were thermal (69.2% scald burns), with a mean total body surface area (TBSA) burned of 4%. The most commonly used drugs were intravenous ketamine (35.7%), intravenous ketamine + midazolam (15.4%), intranasal fentanyl + midazolam (14.1%) and intranasal fentanyl (10.6%). The effectiveness of sedoanalgesia was considered satisfactory in 95.2% of the cases, with an adverse effect rate of 7.5%, without severe adverse effects reported. Conclusions: The use of sedoanalgesia in the ED in the early treatment of childhood burns achieves high effectiveness and safety. It is postulated as a quality indicator; thus, it should be known by all pediatric healthcare practitioners. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

11 pages, 244 KiB

Open AccessArticle

Knowledge of Chinese Pediatric Professionals Regarding Pediatric Pain Management

by Zhen-Zhen Li, Yue-Cune Chang, Lin Gu, Jian-Fu Zhou, Bi-Rong Wei and Niang-Huei Peng

Children 2022, 9(11), 1785; https://doi.org/10.3390/children9111785 - 21 Nov 2022

Cited by 2 | Viewed by 1355

Abstract

Many healthcare professionals base their perceptions of pediatric pain on their knowledge of the subject. Therefore, knowledge deficits in this area may yield negative attitudes toward pain management and add to the complexity of pain management in hospitalized children. This study evaluated the [...] Read more.

Many healthcare professionals base their perceptions of pediatric pain on their knowledge of the subject. Therefore, knowledge deficits in this area may yield negative attitudes toward pain management and add to the complexity of pain management in hospitalized children. This study evaluated the knowledge of pediatric clinicians in China regarding pediatric pain management. Adopting a cross-sectional descriptive comparative design, we surveyed pediatric clinicians using a structured questionnaire. Inclusive criteria were pediatric clinicians, both pediatricians and nurses, with professional pediatric experience of over one year. A total of 507 pediatric clinicians participated. Most were aware of the importance of pain management in sick children but misunderstood pediatric pain, lacked knowledge for performing pediatric pain assessments and lacked knowledge for providing pain relief interventions. Background factors including differing professions (pediatricians and nurses; p = 0.012), age (p < 0.05) and hospital setting of employment (p = 0.003) were significantly related to clinicians’ knowledge regarding pain management. Participating pediatricians had higher levels of knowledge of pediatric pain management than nurses. Research revealed four barriers affecting clinicians’ knowledge, including misconception of pain in children, lack of professional knowledge and confidence in the practice of pediatric pain assessment, lack of professional knowledge to provide pain relief interventions, and a significant knowledge gap between pediatricians and nurses. The results point out a crucial need for multidisciplinary education to remedy these deficiencies. Further study is needed to explore strategies to strengthen clinicians’ knowledge of this vital area of practice. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

13 pages, 400 KiB

Open AccessArticle

The Effect of a Brief Physician-Delivered Neurobiologically Oriented, Cognitive Behavioural Therapy (Brief-CBT) Intervention on Chronic Pain Acceptance in Youth with Chronic Pain—A Randomized Controlled Trial

by Mark K. Simmonds, Bruce D. Dick, Michelle J. Verrier, Kathy L. Reid, Kathryn Jamieson-Lega, Keith J. Balisky, Alison E. Davey and Katherine M. Freeman

Children 2022, 9(9), 1293; https://doi.org/10.3390/children9091293 - 26 Aug 2022

Cited by 1 | Viewed by 1665

Abstract

At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend [...] Read more.

At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance. Using a randomized double blinded methodology, 26 participants received a standard intake assessment and 26 the standard assessment plus the brief-CBT intervention. Measures were taken at three points: pre and post-intake assessment and after Pain 101 or individual CBT (or day 30 post-assessment for those attending neither). The primary outcome measure was the Chronic Pain Acceptance Questionnaire—Adolescent version (CPAQ-A). Comparing pre and post-intake measures, there was a significant (p = 0.002) increase in the CPAQ-A scores—four-fold more in the brief-CBT intervention group (p = 0.045). Anxiety (RCADS-T Score) was significantly reduced post-intake and significantly more reduced in the intervention group compared to the control group (p = 0.024). CPAQ-A scores were significantly increased (p < 0.001) (N = 28) and anxiety (RCADs-T) was significantly reduced by the end of Pain 101 (p < 0.003) (N = 29) as was fear of pain as measured by the Tampa Scale for Kinesiophobia (p = 0.021). A physician-delivered brief-CBT intervention significantly and meaningfully increased CPAQ-A scores and reduced anxiety in youth with chronic pain. Furthermore, CBT through Pain 101 is effective at increasing acceptance, as well as reducing anxiety and fear of movement. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

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8 pages, 432 KiB

Open AccessArticle

The Impact of a Dedicated Sedation Team on the Incidence of Complications in Pediatric Procedural Analgosedation

by Sofia Apostolidou, Mirna Kintscher, Gerhard Schön, Chinedu Ulrich Ebenebe, Hans-Jürgen Bartz, Dominique Singer, Christian Zöllner and Katharina Röher

Children 2022, 9(7), 998; https://doi.org/10.3390/children9070998 - 2 Jul 2022

Cited by 5 | Viewed by 1519

Abstract

The number of pediatric procedural sedations for diagnostic and minor therapeutic procedures performed outside the operating room has increased. Therefore, we established a specialized interdisciplinary team of pediatric anesthesiologists and intensivists (Children’s Analgosedation Team, CAST) at our tertiary-care university hospital and retrospectively analyzed [...] Read more.

The number of pediatric procedural sedations for diagnostic and minor therapeutic procedures performed outside the operating room has increased. Therefore, we established a specialized interdisciplinary team of pediatric anesthesiologists and intensivists (Children’s Analgosedation Team, CAST) at our tertiary-care university hospital and retrospectively analyzed the first year after implementation of the CAST. Within one year, 784 procedural sedations were performed by the CAST; 12.2% of the patients were infants <1 year, 41.9% of the patients were classified as American Society of Anesthesiologists (ASA) grade III or IV. Most children received propofol (79%) and, for painful procedures, additional esketamine (48%). Adverse events occurred in 51 patients (6.5%), with a lack of professional experience (OR 0.60; 95% CI 0.42–0.81) and increased propofol dosage (OR 1.33; 95% CI 1.17–1.55) being significant predictors. Overall, the CAST enabled safe and effective procedural sedation in children outside the operating room. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

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Review

Jump to: Research, Other

11 pages, 2022 KiB

Open AccessReview

Pain Evaluation and Treatment in Children: A Practical Approach

by Lorenzo Sansone, Cristina Gentile, Eleonora Agata Grasso, Armando Di Ludovico, Saverio La Bella, Francesco Chiarelli and Luciana Breda

Children 2023, 10(7), 1212; https://doi.org/10.3390/children10071212 - 13 Jul 2023

Cited by 4 | Viewed by 3098

Abstract

Pain is the most common complaint reported by children who access the emergency departments, but despite its frequency and the availability of many international guidelines, it often remains underreported and undertreated. Recently, the American Academy of Pediatrics and the American Pain Society have [...] Read more.

Pain is the most common complaint reported by children who access the emergency departments, but despite its frequency and the availability of many international guidelines, it often remains underreported and undertreated. Recently, the American Academy of Pediatrics and the American Pain Society have reiterated the importance of a multidisciplinary approach in order to eliminate pain in children. In all pediatric settings, an adequate assessment is the initial stage in a proper clinical approach to pain, especially in the emergency departments; therefore, an increasing number of age-related tools have been validated. A wide range of analgesic agents are currently available for pain management, and they should be tailored according to the patient’s age, the drug’s pharmacokinetics and the intensity of pain. In order to facilitate the choice of the appropriate drug, a treatment algorithm based on a ladder approach can be used. Moreover, non-pharmacological techniques should be considered to alleviate anxiety and distress in pediatric age. This review aims to offer a simple but intuitive description of the best strategies for pain relief in children, starting with the prompt recognition and quantification of pain through adequate assessment scales, and following with the identification of the most appropriate therapeutic choice among the ones available for pediatric age. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

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11 pages, 314 KiB

Open AccessReview

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology

by Laura Mantecón-Fernández, Sonia Lareu-Vidal, Clara González-López, Gonzalo Solís-Sánchez and Marta Suárez-Rodríguez

Children 2023, 10(3), 454; https://doi.org/10.3390/children10030454 - 25 Feb 2023

Cited by 2 | Viewed by 3095

Abstract

Infants might be exposed to pain during their admissions in the neonatal intensive care unit [NICU], both from their underlying conditions and several invasive procedures required during their stay. Considering the particularities of this population, recognition and adequate management of pain continues to [...] Read more.

Infants might be exposed to pain during their admissions in the neonatal intensive care unit [NICU], both from their underlying conditions and several invasive procedures required during their stay. Considering the particularities of this population, recognition and adequate management of pain continues to be a challenge for neonatologists and investigators. Diverse therapies are available for treatment, including non-pharmacological pain management measures and pharmacological agents (sucrose, opioids, midazolam, acetaminophen, topical agents…) and research continues. In recent years one of the most promising drugs for analgesia has been dexmedetomidine, an alpha-2 adrenergic receptor agonist. It has shown a promising efficacy and safety profile as it produces anxiolysis, sedation and analgesia without respiratory depression. Moreover, studies have shown a neuroprotective role in animal models which could be beneficial to neonatal population, especially in preterm newborns. Side effects of this therapy are mainly cardiovascular, but in most studies published, those were not severe and did not require specific therapeutic measures for their resolution. The main objective of this article is to summarize the existing literature on neonatal pain management strategies available and review the efficacy of dexmedetomidine as a new therapy with increasing use in the NICU. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

9 pages, 262 KiB

Open AccessReview

Systemic Lidocaine Infusions for Pediatric Patients with Cancer-Related Pain

by Emily Rav, Rachna Sheth and Ali H. Ahmad

Children 2022, 9(12), 1934; https://doi.org/10.3390/children9121934 - 9 Dec 2022

Cited by 1 | Viewed by 2372

Abstract

Pediatric patients with cancer experience significant distress from both treatment and cancer-related pain. Careful selection of an analgesic regimen should be based upon individual patient factors, including the level of pain, response to therapy, and physiologic profile. Refractory pain is a therapeutic dilemma [...] Read more.

Pediatric patients with cancer experience significant distress from both treatment and cancer-related pain. Careful selection of an analgesic regimen should be based upon individual patient factors, including the level of pain, response to therapy, and physiologic profile. Refractory pain is a therapeutic dilemma frequently encountered in the pediatric cancer setting. Systemic lidocaine infusions have been described as both safe and efficacious, as prior studies show patients reporting decreased pain scores and improved quality of life after lidocaine treatment. Given the favorable side effect profile of lidocaine, it has the potential to be considered for analgesia in the setting of refractory pain. This review discusses the use of systemic lidocaine infusions for analgesia in pediatric oncology patients with cancer-related pain. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

15 pages, 297 KiB

Open AccessReview

The Perioperative Anesthetic Management of the Pediatric Patient with Special Needs: An Overview of Literature

by Alessandra Ciccozzi, Barbara Pizzi, Alessandro Vittori, Alba Piroli, Gioele Marrocco, Federica Della Vecchia, Marco Cascella, Emiliano Petrucci and Franco Marinangeli

Children 2022, 9(10), 1438; https://doi.org/10.3390/children9101438 - 21 Sep 2022

Cited by 4 | Viewed by 3156

Abstract

The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible. This article reports an overview of the anesthetic [...] Read more.

The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible. This article reports an overview of the anesthetic management of non-cooperative patients between 6 and 14 years old. The pathologies most frequently responsible for psycho-physical disorders can be summarized into three groups: (1) collaboration difficulties (autism spectrum disorders, intellectual impairment, phobia); (2) motor dysfunction (cerebral palsy, epilepsy, other brain pathologies, neuromuscular disorders), and (3) craniofacial anomalies (Down syndrome, other genetic syndromes). Anesthesia can be performed safely and successfully due to careful management of all specific problems of these patients, such as a difficult preoperative evaluation (medical history, physical examination, blood sampling, evaluation of vital parameters and predictive indices of difficult airway) and the inapplicability of a “standard” perioperative path (timing and length of the hospitalization, anesthetic premedication, postoperative management). It is necessary to ensure a dedicated perioperative process that is safe, comfortable, tailored to specific needs, and as less traumatic as possible. At the same time, all necessary precautions must be taken to minimize possible complications. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

Other

Jump to: Research, Review

6 pages, 912 KiB

Open AccessCase Report

Baastrup’s Disease in Pediatric Gymnasts

by Arsalan Akbar Ali, Benjamin Matthew Jacobs, Artee Gandhi and Meredith Brooks

Children 2022, 9(7), 1018; https://doi.org/10.3390/children9071018 - 8 Jul 2022

Cited by 2 | Viewed by 2219

Abstract

Baastrup’s disease is a rare, often misdiagnosed, and causes back pain in children. It is characterized by degenerative changes of both spinous processes and interspinous soft tissues between two adjacent vertebrae. Repetitive spinal movements in the sagittal plane predispose injury to posterior elements [...] Read more.

Baastrup’s disease is a rare, often misdiagnosed, and causes back pain in children. It is characterized by degenerative changes of both spinous processes and interspinous soft tissues between two adjacent vertebrae. Repetitive spinal movements in the sagittal plane predispose injury to posterior elements of the spine. Chronic flexion and extension strain the interspinous ligament, causing the neighboring spinous processes to adjoin. Patients typically report midline back pain in the lumbar region, which radiates both cephalad and caudad but not laterally. Pain is aggravated by extension and palpation and is alleviated with flexion. Some children with Baastrup’s do not experience pain but present with swelling along the spinous processes. Diagnosis is dependent on distinctive radiologic findings and exam features. Increased interspinous spaces and bone remodeling may be observed. While the current treatment for pain associated with Baastrup’s is directed towards physical therapy, massage therapy, nonsteroidal anti-inflammatory medications, muscle relaxants, and rest from activity, this is the first report of children undergoing interventional modalities for the treatment of back pain associated with Baastrup’s disease. We present two unique pediatric cases of female gymnasts with Baastrup’s disease who were successfully treated by two different techniques: interspinous ligament injection and medial branch block. Full article

(This article belongs to the Special Issue Pain and Therapeutic Interventions in Children)

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