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1.

Background/Purpose

The purpose of this study was to examine children’s temperament as a predictor of post-operative analgesics administered by parents after controlling for post-operative pain severity, surgery severity, and parental misconceptions regarding pain medication for children.

Methods

Participants included 286 Spanish- and English-speaking parents of children ages 1–18 (IQR: 3–8) undergoing outpatient elective surgery. Parents completed measures of baseline temperament, parental medication attitudes, and demographics preceding their child’s surgery and recorded pain intensity and doses of analgesics administered (nonopioid and opioid) on postoperative days 1, 3, and 7.

Results

Pearson product–moment correlations revealed that emotionality was significantly associated with acetaminophen, ibuprofen and hydrocodone and shyness was significantly associated with acetaminophen and hydrocodone. Hierarchical linear regression analysis revealed emotionality as a significant independent predictor of acetaminophen, ibuprofen and hydrocodone administered (F(4, 72) = 2.82, F(4, 73) = 1.53, F(4, 58) = 8.75, respectively).

Conclusion

Dimensions of children’s temperament, specifically emotionality, predict analgesic administration by parents following surgery even after controlling for confounding variables. These findings highlight the need for tailored interventions targeting management of children’s pain in the home setting and suggest that both proximal (e.g., pain severity) and distal (e.g., child temperament) factors may be necessary intervention components.  相似文献
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Objective: Pediatric hypnosis has a useful role in pre‐, peri‐, and post‐anesthesia to minimize anticipatory anxiety, and as adjunctive treatment to reduce and control pain. This article reviews the literature in the use of hypnosis in pediatric anesthesia to highlight its role and relevancy. Background: Current research indicates there is an immediate and enduring impact, and long‐term benefits of this child‐centered intervention. Hypnosis can be included in presurgical consultations to establish cooperation and signals for increasing comfort and to address fears and provide suggestions for rapid recovery with changed expectations for the child’s own benefit. Thus prepared, the child is in a heightened state of receptivity and statements and suggestions carry through to peri‐ and post‐anesthesia, when hypnosis can help with extubation, reduce nausea, and ease recovery. Method: The Magic Glove is one hypno‐anesthesia technique that simultaneously addresses pain and anxiety. The process of hypnosis requires training and supervised practice. Conclusion: Patients in hypnosis treatment conditions have less anxiety and shorter hospital stays and experience less long‐term pain and discomfort than do patients in control conditions. There appears little reason not to provide hypnosis as an adjunctive treatment for pediatric patients undergoing anesthesia.  相似文献
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Background: This prospective randomized controlled study was undertaken to evaluate the efficacy of palatal block i.e. blocking of naso palatine, greater and also lesser palatine nerves in children with cleft palate undergoing palatoplasty by evaluating its effects on intraoperative anesthetic requirement, postoperative analgesia and parental satisfaction. Methods: Forty‐five pediatric patients aged below five undergoing cleft palate repair were randomly allocated to three groups of 15 each. After tracheal intubation, Group NB received no block for control, group S received 0.5 ml of normal saline and group B received 0.5 ml of 0.25% bupivacaine for palatal block. Postoperative pain score, the time to first demand of analgesia and number of rescue analgesic demands were noted. Finally, the parental satisfaction was graded. Results: The block had no anesthetic sparing effect. The mean pain scores were significantly lower in patients who received block than in the group NB. The mean area under curve for FLACC score in group NB was 29 with 95% CI of 25–32, group S was 15 with 95% CI of 8.9–22.3 and in group B, it was 10 with 95% CI of 6–14. The time to first demand of analgesia was 6 [4.5–6] h in group NB, 18 [6–18] h in group S and 18 [18–18] h in group B (P‐0.000). The number of demands of rescue analgesia was significantly less in group B 0 [0–0.25], 0 [0–2] in S group compared to group NB 3 [3–3] (P‐0.000). The parental satisfaction was good in patients who received block and poor in group NB. Conclusion: Palatal block is technically simple, safe and effectively provides postoperative analgesia with good parental satisfaction. Injection of saline also produced palatal nerve block; however, the effect was not consistent.  相似文献
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Aim:  To further investigate the effect of acupuncture in postoperative pain and emergence agitation in children undergoing bilateral myringotomy and tympanostomy tube (BMT) placement.
Background:  BMT insertion surgery in children is routinely performed under general anesthesia and is associated with a high incidence of postoperative pain and agitation upon emergence from anesthesia. Various medications have been investigated to alleviate the pain and agitation, which have been accompanied by high incidence of adverse effects. In children, anecdotal reports suggest that acupuncture may offer postoperative analgesia.
Methods/Materials:  This prospective randomized controlled trial is to evaluate the effectiveness of acupuncture to control pain and agitation after initial bilateral myringotomy tube placement in 60 nonpremedicated children. Acupuncture was applied at points LI-4 (he gu) and HT-7 (shen men) immediately after induction of anesthesia. A single-blinded assessor evaluated postoperative pain and agitation using CHEOPS and emergence agitation scale. Pain and agitation scores were significantly lower in the acupuncture group compared to those in the control group at the time of arrival in the post anesthesia care unit and during the subsequent 30 min.
Results:  Acupuncture treatment provided significant benefit in pain and agitation reduction. The median time to first postoperative analgesic (acetaminophen) administration was significantly shorter in the control group. The number of patients who required analgesia was considerably fewer in the acupuncture group than that in the control. No adverse effects related to acupuncture treatment were observed.
Conclusion:  Our study suggests that acupuncture therapy may be effective in diminishing both pain and emergence agitation in children after BMT insertion without adverse effects.  相似文献
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Background:  Until recently, individual doctors and nurses in our pediatric hospital made decisions about the application of pain relief in patients, resulting in a wide variety of practice. The main task of our pain group was to develop hospital-wide practice standards for acute pain management to improve care. One of the key points of the pain policy was the introduction of pain assessment tools (COMFORT and Visual Analogue Scale).
Methods:  A project team supported by the Institute for Healthcare Improvement (CBO) collaborated during 1 year. The pain policy and in particular, the pain assessment tools, were implemented in the postanesthetic care unit (PACU) and surgical ward. The following targets were set: pain assessment will be performed in 95% of cases and the severity of pain will be 'no or mild pain' in 95% of cases.
Results:  During the study period, 37% of all proposed pain assessments could be retrieved. The maximum retrievement score was 68%. In 80% of patients, at least one pain score was retrieved. The scores were divided as follows: 67% no or mild pain, 11% moderate pain, 1% severe pain. In the PACU, over 80% of pain assessments were retrieved; in six study weeks, the aimed score of 95% was reached; 94% of patients reported no or mild pain at departure.
Conclusions:  Implementation of a pain policy in a pediatric hospital is a difficult process. Pain management in the PACU fell just short of the set target performances. In the surgical ward, embedding the importance of pain assessment remains a challenge and a prerequisite for quality of care in pain management.  相似文献
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BACKGROUND: Ketobemidone has been used as an analgesic for postoperative pain in children, but to our knowledge the effect and occurrence of adverse effects of ketobemidone compared to morphine is not known. The aim was to determine if the analgesic potency and the occurrence of adverse effects of ketobemidone differ from morphine when administered to children, as measured by patient-controlled analgesia consumption (PCA) for postoperative pain. METHODS: Sixty healthy children, aged 6 to 16 years, scheduled for elective surgery were randomized to receive either ketobemidone (Ke) 1 mg ml(-1) or morphine (Mo) 1 mg ml(-1) for postoperative pain through PCA. Drug consumption (microg kg(-1) h(-1)), the number of PCA doses, pain intensity, and adverse effects were recorded at regular intervals. RESULTS: Data on total drug consumption were based on 26 children in the Ke group and 28 in the Mo group. A non-statistically significant difference for total mean consumption of ketobemidone (18.6 microg kg(-1)h(-1)) and morphine (23.2 microg kg(-1)h(-1)) was obtained. The mean dose ratio (Mo/Ke) was 0.80 and the median was 0.94. Children's characteristics, loading dose, PCA doses, VAS scores, and adverse effects showed no significant differences between the groups. CONCLUSION: The analgesic potency and adverse effects of ketobemidone are similar to morphine when used for postoperative pain management in children.  相似文献
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