Pain score documentation and analgesia: A comparison of children and adults with appendicitis

Furyk, Jeremy; Sumner, Michelle

doi:10.1111/j.1742-6723.2008.01133.x

Cited by 29 publications

(20 citation statements)

References 28 publications

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“…There were no major SAEs in this trial. 38 Younge et al randomized 47 patients to IN fentanyl at 1 μg/kg or morphine sulfate 0.2 mg/kg IM in the ED setting. Intranasal fentanyl was more effective than IM morphine at 10 minutes, although the result did not reach statistical significance (p < 0.14).…”

Section: Safety and Efficacymentioning

confidence: 99%

See 1 more Smart Citation

An Evidence-based Guideline for Prehospital Analgesia in Trauma

Gausche‐Hill¹,

Brown²,

Oliver³

et al. 2013

Prehospital Emergency Care

120

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Background. The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. Objective. To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children's research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council. Results. Four strong

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Section: Safety and Efficacymentioning

confidence: 99%

“…45 Other pediatric emergency department based studies reported similar efficacy and safety results. 37,38,46 Doses Studies looking at IV or IN fentanyl generally used 1-2 μg/kg, although dosing up to 4 μg/kg was used for IN fentanyl. Dosing for morphine was less commonly reported on a mg/kg basis.…”

Section: Safety and Efficacymentioning

confidence: 99%

An Evidence-based Guideline for Prehospital Analgesia in Trauma

Gausche‐Hill¹,

Brown²,

Oliver³

et al. 2013

Prehospital Emergency Care

120

View full text Add to dashboard Cite

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“…Finally, the results of this survey did not evaluate PEPs' actual practice regarding analgesic timing or dosing. These are all well-described components of suboptimal analgesia in children [1][2][3][4][5] and issues that could be explored in future work.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence suggests that analgesia is underutilized for acute abdominal pain [1][2][3][4][5] , delayed in its administration, [1][2][3] and dosed insufficiently 1,3 in the emergency department (ED) setting. Compared to adults, children are at particular risk for suboptimal analgesia and have been found to receive analgesia less often.…”

Section: Introductionmentioning

confidence: 99%

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Poonai

Cowie

Davidson

et al. 2016

CJEM

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Objectives: Evidence exists that analgesics are underutilized, delayed, and insufficiently dosed for emergency department (ED) patients with acute abdominal pain. For physicians practicing in a Canadian paediatric ED setting, we (1) explored theoretical practice variation in the provision of analgesia to children with acute abdominal pain; (2) identified reasons for withholding analgesia; and (3) evaluated the relationship between providing analgesia and surgical consultation. Methods: Physician members of Paediatric Emergency Research Canada (PERC) were prospectively surveyed and presented with three scenarios of undifferentiated acute abdominal pain to assess management. A modified Dillman's Tailored Design method was used to distribute the survey from June to July 2014. Results: Overall response rate was 74.5% (149/200); 51.7% of respondents were female and mean age was 44 (SD 8.4) years. The reported rates of providing analgesia for case scenarios representative of renal colic, appendicitis, and intussusception, were 100%, 92.1%, and 83.4%, respectively, while rates of providing intravenous opioids were 85.2%, 58.6%, and 12.4%, respectively. In all 60 responses where the respondent indicated they would obtain a surgical consultation, analgesia would be provided. In the 35 responses where analgesia would be withheld, 21 (60%) believed pain was not severe enough, while 5 (14.3%) indicated it would obscure a surgical condition. Conclusions: Pediatric emergency physicians self-reported rates of providing analgesia for acute abdominal pain scenarios were higher than previously reported, and appeared unrelated to request for surgical consultation. However, an unwillingness to provide opioid analgesia, belief that analgesia can obscure a surgical condition, and failure to take self-reported pain at face value remain, suggesting that the need exists for further knowledge translation efforts. RÉSUMÉObjectifs: D'après des données, il y a une sous-utilisation, un report de l'administration et un dosage insuffisant de l'analgésie dans les services des urgences (SU) chez les patients souffrant de douleurs abdominales aiguës. En ce qui concerne les médecins qui pratiquent dans les services des urgences pédiatriques (SUP) au Canada, les auteurs ont : 1) examiné les différences de pratique théorique dans l'administration de l'analgésie chez les enfants souffrant de douleurs abdominales aiguës; 2) cerné les motifs à l'appui du report de l'administration de l'analgésie; et 3) évalué le lien entre l'administration de l'analgésie et les consultations en chirurgie.

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“…5,6 There is ample evidence that analgesia is underused in the ED setting. [7][8][9][10] Furthermore, untreated pain in childhood has been reported to lead to slower healing [11][12][13][14] and long-term issues, such as anxiety, needle phobia, 15 hyperesthesia, 13 and fear of medical care. 16 Despite general acceptance that children experience significant pain-related urethral procedures, [17][18][19] suboptimal analgesia is particularly prevalent in children undergoing UC, with analgesic rates ranging from 0% 6 to 2%.…”

Section: What This Study Addsmentioning

confidence: 99%

Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial

Poonai

Langford

et al. 2015

Pediatrics

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To determine whether lidocaine is superior to nonanesthetic lubricant (NAL) for relieving pain in children undergoing urethral catheterization (UC).METHODS: Children 0 to 24 months requiring UC were randomized to NAL or topical and intraurethral 2% lidocaine gel. Primary outcome was facial grimacing in the pre to during drug administration and catheterization phases. Secondary outcome was caregiver satisfaction by using a Visual Analog Scale.RESULTS: There were 133 participants (n = 68 lidocaine, n = 65 NAL). There were no significant differences in mean ( There were no significant differences in mean (SD) parental satisfaction scores between lidocaine and NAL (4.8 [3.2] vs 5.9 [2.9]), respectively (CI-0.1 to 2.2; P = .06). In the subgroup analysis, age, gender, and positive urine culture did not significantly influence between-group differences in facial grimacing.CONCLUSIONS: Compared with NAL, topical and intraurethral lidocaine is not associated with significant pain reduction during UC, but significantly greater pain during instillation. Therefore, clinicians may consider using noninvasive pain-reducing strategies for young children who require UC. WHAT'S KNOWN ON THIS SUBJECT:Urethral catheterization is a painful, yet common procedure to obtain a sterile urine sample in young children. There are conflicting results regarding the effectiveness of lidocaine to reduce pain, and it is unclear if it should be routinely used. WHAT THIS STUDY ADDS:In young children, combined topical and intraurethral lidocaine does not reduce pain during urethral catheterization and is associated with more pain than nonanesthetic lubricant during instillation. Clinicians should use noninvasive methods of analgesia during this painful procedure.

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Pain score documentation and analgesia: A comparison of children and adults with appendicitis

Abstract: Documentation of pain scores and provision of i.v. morphine is generally poor. Children are less likely than adults to have a pain score documented, or receive i.v. morphine when presenting with appendicitis.

Cited by 29 publications

References 28 publications

An Evidence-based Guideline for Prehospital Analgesia in Trauma

An Evidence-based Guideline for Prehospital Analgesia in Trauma

Reported provision of analgesia to patients with acute abdominal pain in Canadian paediatric emergency departments

Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial

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