The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years

Objectives:  To evaluate the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural pain in children aged 5–16 years.
Background:  Self-reporting of pain is considered to be the primary source of information on pain intensity for older children but a validated observational tool will provide augment information to self-reports during painful procedures.
Methods:  Eighty children scheduled for peripheral venous cannulation or percutaneous puncture of a venous port were included. In 40 cases two nurses simultaneously and independently assessed pain by using the FLACC scale and in 40 cases one of these nurses assessed the child. All children scored the intensity of pain by using the Coloured Analogue Scale (CAS) and distress by the Facial Affective Scale (FAS).
Results:  Concurrent validity was supported by the correlation between FLACC scores and the children's self-reported CAS scores during the procedure ( r  = 0.59, P  < 0.05). A weaker correlation was found between the FLACC scores and children's self-reported FAS ( r  = 0.35, P  < 0.05). Construct validity was demonstrated by the increase in median FLACC score to 1 during the procedure compared with 0 before and after the procedure ( P  < 0.001). Interrater reliability during the procedure was supported by adequate kappa statistics for all items and for the total FLACC scores (κ = 0.85, P  < 0.001).
Conclusions:  The findings of this study support the use of FLACC as a valid and reliable tool for assessing procedural pain in children aged 5–16 years.     

Recovery characteristics of sevoflurane or halothane for day-case anaesthesia in children aged 1-3 years

BACKGROUND: Our objective was to compare the recovery characteristics of sevoflurane and halothane for short day-case anaesthesia in a specifically limited age group of children 1-3 yr. METHODS: Eighty unpremedicated children undergoing day-case adenoidectomy were randomly assigned to receive inhalational induction with either sevoflurane 8% or halothane 5% and nitrous oxide in oxygen (70/30) via a face mask. Tracheal intubation was performed without a muscle relaxant. Anaesthesia was continued with the volatile anaesthetic, adjusted to maintain heart rate and blood pressure within +/-20% of initial values. Recovery was evaluated using a modified Aldrete score, a Pain/Discomfort scale and by measuring recovery end-points. A postoperative questionnaire was used to determine the well-being of the child at home until 24 h after discharge. RESULTS: Emergence and interaction occurred significantly earlier after sevoflurane than halothane but discharge times were similar. More children in the sevoflurane group achieved full Aldrete scores within the first 30 min after anaesthesia, although this group suffered more discomfort during the first 10 min. The amount of postoperative analgesic administered was higher and the first dose given earlier in the sevoflurane group. Postoperative vomiting was more common with halothane, but side-effects in the two groups were otherwise similar in the recovery room and at home. CONCLUSIONS: In children 1-3 yr, sevoflurane provided more rapid early recovery but not discharge after anaesthesia of <30-min duration. Apart from more vomiting with halothane and more discomfort during the first 10 min after awakening with sevoflurane, the quality of recovery was similar with the two anaesthestics.     

Hormonal and metabolic stress responses after major surgery in children aged 0-3 years: a double-blind, randomized trial comparing the effects of continuous versus intermittent morphine

Children aged 0–3 yr were stratified for age and randomizedto receive either continuous morphine (CM, 10 µg kg^–1 h^–1)with three-hourly placebo boluses or intermittent morphine (IM,30 µg kg^–1 every 3 h) with a placeboinfusion for postoperative analgesia. Plasma concentrationsof epinephrine, norepinephrine, insulin, glucose and lactatewere measured before and at the end of surgery and 6, 12 and24 h after surgery. Pain was assessed with validated painscales [the COMFORT scale and a visual analogue scale (VAS)]with the availability of additional morphine doses. Minor differencesoccurred between the randomized treatment groups, the oldestIM group (aged 1–3 yr) having a higher blood glucoseconcentration (P=0.003), mean arterial pressure (P=0.02) andCOMFORT score (P=0.02) than the CM group. In the neonates, preoperativeplasma concentrations of norepinephrine (P=0.01) and lactate(P<0.001) were significantly higher, while the postoperativeplasma concentrations of epinephrine were significantly lower(P<0.001) and plasma concentrations of insulin significantlyhigher (P<0.005) than in the older age groups. Postoperativepain scores (P<0.003) and morphine consumption (P<0.001)were significantly lower in the neonates than in the older agegroups. Our results show that continuous infusion of morphinedoes not provide any major advantages over intermittent morphineboluses for postoperative analgesia in neonates and infants. Br J Anaesth 2001; 87: 390–9