The Impact of Medical Clowns Exposure over Postoperative Pain and Anxiety in Children and Caregivers: An Israeli Experience

Abstract

While postoperative pain management was shown to reduce unwanted physiological and emotional outcomes, pediatric postoperative pain management remains suboptimal. Medical-clowns were shown to be beneficial in many medical contexts including reduction of stress, anxiety and pain. This study was set to assess the effectiveness of medical-clowns on pediatric postoperative pain reduction. Children age 4 or above, planned for elective hernia repair surgery were recruited. Children were randomly divided to a control or medicalclown escorted groups. Demographical and clinical data were collected using questionnaires and electronic sheets. Children escorted by clowns reported lower levels of pain upon admittance, discharge and 12-hours post-surgery. Statistically significant reduction of parental distress and significantly higher serum cortisol levels were observed in the clown-therapy group. Although small, our study supports the possibility that preoperative medical-clown therapy might be a cheap, safe and yet beneficial method for postoperative pain reduction.

Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials

“… 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 63 64 65 66 67 68 69 Only one study exclusively included male patients 62 because the study population included children undergoing outpatient penile surgery. Fourteen studies exclusively involved children in hospital (age 2-12), 46 47 48 49 50 52 57 59 60 61 62 63 64 67 and the 10 remaining studies included both children and adolescents in hospital (age 13-18). 51 53 54 55 56 58 65 66 68 69 The mean sample size among studies was 67.16 (standard deviation 57.22, range 6-306).…”

“… 51 53 54 55 56 58 65 66 68 69 The mean sample size among studies was 67.16 (standard deviation 57.22, range 6-306). 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 …”

“… 46 47 48 55 56 57 58 59 62 64 Only three studies used a biomarker (salivary cortisol) to assess stress outcome. 63 65 67 Two recent studies used a panel of biomarkers to assess psychological stress and cancer related fatigue, including cortisol, α amylase, pro-inflammatory cytokines, anti-inflammatory cytokines, and matrix metalloproteinases. 66 69 …”

“…Regarding the revised RoB 2, most of the randomised controlled trials 46 47 48 52 53 56 57 58 61 62 67 (n=11; 85%) were rated as having some concerns, and only two 51 60 were rated as having a high risk of bias ( fig 3 and fig 4 ). Only five randomised controlled trials 48 52 53 61 62 (n=5; 38%) were rated as having a low risk of bias arising from the randomisation process, whereas the remaining randomised controlled trials 46 47 51 52 57 58 60 67 (n=8; 62%) were rated as having some concerns for this domain. Most randomised controlled trials (n=9; 69%) 48 52 53 56 57 58 61 62 67 had a low risk of bias in the selection of the reported result.…”

“…Only five randomised controlled trials 48 52 53 61 62 (n=5; 38%) were rated as having a low risk of bias arising from the randomisation process, whereas the remaining randomised controlled trials 46 47 51 52 57 58 60 67 (n=8; 62%) were rated as having some concerns for this domain. Most randomised controlled trials (n=9; 69%) 48 52 53 56 57 58 61 62 67 had a low risk of bias in the selection of the reported result.…”