Procedural pain in children: evidence-based best practice and guidelines

Murat, I.; Gall, Olivier Le; Tourniaire, B.

doi:10.1016/j.rapm.2003.08.023

Cited by 21 publications

(24 citation statements)

References 133 publications

(126 reference statements)

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“…Management may include analgesic agents via different routes of administration, concurrent sedation or general anaesthesia, and non-pharmacological methods. The choice of technique will depend on the age and previous experience of the child, the type of procedure, the expected intensity and duration of pain, the treatment environment and available resources (Murat et al, 2003). Sedation alone must not be seen as an alternative to appropriate analgesia, particularly when pain is expected after completion of the procedure.…”

Section: Management Of Procedural Painmentioning

confidence: 99%

“…IV regional block with local anaesthetic was safe and effective in 90% to 98% of cases (Murat et al, 2003 Level I), but complications may arise with faulty equipment, inappropriate use of local anaesthetic, or inadequate monitoring and training of staff. Inhalation of N 2 O was as effective as IV regional anaesthesia using lignocaine Level III-1) and better than IM analgesia and sedation with pethidine (meperidine) and promethazine (Evans et al, 1995 Level III-1), although N 2 O has recently been reported to have limited efficacy as a sole agent for fracture manipulation (Babl et al, 2008 Level IV).…”

Section: Chapter 10mentioning

confidence: 99%

“…Ketamine-midazolam reduced distress during fracture manipulation and fewer paediatric patients required airway interventions than those receiving fentanyl-midazolam and propofol-fentanyl Level I). As there is the potential for complications and a high incidence of side effects with sedative agents, particularly when given in combination (Cote et al, 2000;Cote, 2008) or in children with comorbidities (Morton, 2008), fully monitored general anaesthesia may be more appropriate than sedation or local anaesthesia in some clinical settings (Murat et al, 2003).…”

Section: Chapter 10mentioning

confidence: 99%

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Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Management Of Procedural Painmentioning

confidence: 99%

Section: Chapter 10mentioning

confidence: 99%

Section: Chapter 10mentioning

confidence: 99%

See 1 more Smart Citation

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…Douleurs provoquées par les soins chez l'enfant ; bonnes pratiques fondées sur l'évidence et les recommandations [27] Cent trente-quatre références ont été analysées. L'auteur conclut : « la littérature est en faveur de l'utilisation de la kétamine avec de petites doses initialement (titration), les incidents étant plus importants au-delà de 2 mg/kg, avec majoritairement des problèmes respiratoires et un temps de récupération plus long.…”

Section: Autres Revues De La Littérature Sans Consensus D'expertsunclassified

Ketamine for paediatric procedure-related pain

Annequin

2010

Douleur analg

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Les premières recommandations françaises de l'Agence française de sécurité sanitaire des produits de santé (Afssaps) de bonne pratique pour la réalisation de soins et d'actes douloureux chez l'enfant ont été finalisées en 2009 ; il n'existait pas jusqu'alors en France, de recommandations permettant de faire bénéficier les enfants d'une sédation-analgésie plus puissante que le mélange équimoléculaire oxygène-protoxyde d'azote (MEOPA), dont l'efficacité est inconstante. Pour effectuer dans de bonnes conditions un geste douloureux, la kétamine à faible dose (titration de bolus intraveineux [i.v.] de 0,5 mg/kg sans dépasser 2 mg/kg) apparaît comme étant le seul médicament potentiellement utilisable par un médecin formé, sans la présence d'un médecin anesthésiste. Avec ces posologies, sans association médica-menteuse, le niveau de sécurité optimal dépend largement de la qualité de l'environnement hospitalier. La voie intramusculaire (i.m.) (< 4 mg/kg) est une alternative (si la voie intraveineuse n'est pas facilement disponible), mais le délai de récupération est retardé. Mots clés Kétamine · Douleur provoquée par les soins · Enfant · Sécurité · RecommandationAbstract For painful procedures, there was not any recommendations in France to date allowing children to benefit from more powerful sedation-analgesia than nitrous oxideoxygen mixture, whose efficacy is inconsistent. In order to perform a painful procedure under good conditions, lowdose ketamine (0.5 mg/kg IV. bolus titration, not exceeding 2 mg/kg) appears to be the only medication that can be used by a trained physician, without requiring the presence of an anesthesiologist). With these posologies, with no drug combinations, the optimum safety level is largely governed by the quality of the hospital environment. The intramuscular route (< 4 mg/kg) is an alternative (if the IV route is not readily available), but the recovery time is delayed.

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“…Recommendations for reduction in procedural pain therefore may be quite different in the situation of traumatic injury, in contrast to a scheduled elective procedure in which an appropriate expectation of patient cooperation and NPO status reduces risk. Murat et al 1 evaluate the evidence provided in the literature and offer recommendations based on evidence and reason.…”

mentioning

confidence: 99%

Pain prevention strategies that work

Tobin

2003

Regional Anesthesia and Pain Medicine

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Procedural pain in children: evidence-based best practice and guidelines

Cited by 21 publications

References 133 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Ketamine for paediatric procedure-related pain

Pain prevention strategies that work

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