Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies

Büttner, W; Finke, W

doi:10.1046/j.1460-9592.2000.00530.x

Cited by 292 publications

(209 citation statements)

References 37 publications

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“…If there were no contraindications with the first dose given at the end of surgery, the following non-steroidal anti-inflammatory drugs were administered as part of multimodal analgesia management: niflumic acid 40 mg Á kg -1 rectally or ketoprofene 2 mg Á kg -1 iv twice daily and paracetamol 15 mg Á kg -1 iv or po four times daily. Pain scores for children \7 years old were evaluated by the Children and Infants Postoperative Pain Score (CHIPPS), 9 and pain scores in older children were evaluated by the visual analog scale (VAS) ranging from 0 = no pain to 10 = worst imaginable pain. If pain control was considered insufficient (i.e., VAS or CHIPPS score [3), nalbuphine 0.2 mg Á kg -1 (four times daily), tramadol 0.5 mg Á kg -1 (four times daily), or intravenous patientcontrolled morphine analgesia were administered as rescue analgesics.…”

Section: Methodsmentioning

confidence: 99%

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Dadure

Bringuier

Raux³

et al. 2009

Can J Anesth/J Can Anesth

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Introduction Perioperative continuous peripheral nerve blocks (CPNB) are increasingly being used in children. Only one previous study has reported adverse events of CPNB in a high number of pediatric cases. We evaluated the indications, block efficacy, and adverse events related to CPNB in children. Methods All CPNBs that were performed in children for postoperative analgesia over a 5-year period at the Montpellier University Hospital in France were included in this study. The first bolus dose and the continuous doses of local anesthetic were not standardized. In the postoperative period, demographic data, quality of analgesia, amount of rescue analgesic medication, child/parent satisfaction, and adverse events were recorded in our Departmental Regional Anesthesia registry. Results A total of 339 catheters were evaluated in 292 children ASA physical status I to III. The median age was 8 yr (0.6-17 yr) and the median weight was 28 kg (7-116 kg). The main surgical indications were hip, femoral, or tibial osteotomies (44.5%) and club foot repair (27.4%). The local anesthetics used were either bupivacaine or ropivacaine. The mean volume of the local anesthetic bolus dose was 0.49 ± 0.16 mL Á kg -1 , and the mean regimen of local anesthetic continuous infusion was 0.11 ± 0.04 mL Á kg -1 Á hr -1 . The median duration of CPNB was 61.6 hr (range 0-264 hr). Pain relief, which was evaluated with the children at rest, was considered optimal in the majority of patients throughout the study period. The Children and Infants Postoperative Pain Scale (CHIPPS) was used in children age 0-6 yr and the Visual Analog Pain Scale (VAS) was used in children 7 yr and older. There were no major adverse events. There were 211 minor adverse events recorded in 153 CPNBs (45.1%). The most frequently reported complication (20.1%) involved mechanical problems with the catheter, followed by nausea and vomiting (14.7%). Conclusion CPNBs are indicated after orthopedic surgery in children. Our results demonstrate that CPNBs are feasible in the pediatric setting, and in skilled hands, they promote prolonged analgesia in the majority of patients without major adverse events. The most common minor adverse events are catheter-related mechanical problems and postoperative nausea and vomiting.

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Section: Methodsmentioning

confidence: 99%

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Dadure

Bringuier

Raux³

et al. 2009

Can J Anesth/J Can Anesth

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“…One must consider the lack of validated pain-assessment tools to evaluate ongoing pain and discomfort in mechanically ventilated preterm neonates. 54,75,76,88,116,123,124 Numerous randomized, controlled trials have evaluated pain control in mechanically ventilated newborns, but many have been underpowered. 19,39,102,[125][126][127][128] Two recent appropriately powered studies enrolled a total of 1048 neonates and demonstrated no differences in the incidence of severe intraventricular hemorrhage, periventricular leukomalacia, or death outcomes between the ventilated infants who received morphine or placebo infusions.…”

Section: Procedural Painmentioning

confidence: 99%

“…Therefore, many of the standard study instruments used for measuring the efficacy of analgesia or defining the goals of sedation or analgesia cannot be applied in this population. 123 The neonatal pain-control group discussed the difficulties of using pain-assessment scales. Many studies on methods for evaluating pain or distress in neonates have examined behaviors, physiologic parameters, and other variables as responses to pain.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…It is difficult even for trained nursing personnel to accurately assess pain as evidenced by the frequent use of supplemental pain medications given to both treatment groups in placebo-controlled trials. [122][123][124] ETHICAL ISSUES Unlike studies conducted in adults, clinical trials involving neonates face the ethical constraint of the inability to incorporate a placebo that withholds analgesia for any length of time. The key ethical questions discussed by the neonatal pain-control group concerned the appropriateness of using placebos in different circumstances.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Summary Proceedings From the Neonatal Pain-Control Group

et al. 2006

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Recent advances in neurobiology and clinical medicine have established that the fetus and newborn may experience acute, established, and chronic pain. They respond to such noxious stimuli by a series of complex biochemical, physiologic, and behavioral alterations. Studies have concluded that controlling pain experience is beneficial with respect to short-term and perhaps long-term outcomes. Yet, pain-control measures are adopted infrequently because of unresolved scientific issues and lack of appreciation for the need for control of pain and its long-term sequelae during the critical phases of neurologic maturation in the preterm and term newborn. The neonatal pain-control group, as part of the Newborn Drug Development Initiative (NDDI) Workshop I, addressed these concerns. The specific issues addressed were (1) management of pain associated with invasive procedures, (2) provision of sedation and analgesia during mechanical ventilation, and (3) mitigation of pain and stress responses during and after surgery in the newborn infant. The cross-cutting themes addressed within each category included (1) clinical-trial designs, (2) drug prioritization, (3) ethical constraints, (4) gaps in our knowledge, and (5) future research needs. This article provides a summary of the discussions and deliberations. Full-length articles on procedural pain, sedation and analgesia for ventilated infants, perioperative pain, and study designs for neonatal pain research were published in Clinical Therapeutics (June 2005).www.pediatrics.org/cgi

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“…Examples of some other tools are: CHIPPS (which considers crying, facial expression, posture of trunk, posture of legs and motor restlessness) 2 , CRIES (which is an acronym for Crying, Requires oxygen to maintain a saturation > 95%, Increased blood pressure and heart rate, Expression, Sleep state) 3 and The Comfort Scale (in which variables are: alertness, calmness/agitation, respiratory response, physical movement, mean arterial pressure, heart rate, muscle tone and facial expression) 4 . Although these are simple and useful tools there is no correlation between pain scores and the treatment required, a limitation of these measurement methods.…”

mentioning

confidence: 99%