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Anales de Pediatria Dec 2022Pain and the anxiety that it produces are the main sources of suffering in children managed in emergency departments, eliciting a growing interest in parents and health...
Pain and the anxiety that it produces are the main sources of suffering in children managed in emergency departments, eliciting a growing interest in parents and health care providers in the adequate provision of sedation and analgesia. In consequence, the number of diagnostic and therapeutic procedures that require sedation and/or analgesia in paediatric emergency departments has increased in recent years, which has generated a need to train non-anaesthesiologists on how to provide this care without affecting patient safety. The objective of this document is to establish evidence-based recommendations, developed by consensus by the Working Group on Sedation and Analgesia of the Sociedad Española de Urgencias de Pediatría, regarding the competencies and training of staff who perform sedation or analgesia procedures to achieve the greatest possible quality in the management of paediatric patients before, during and after these procedures in the paediatric emergency care setting. The consensus document has been structured in two parts: the first addresses the competencies of non-anaesthesiologists who perform sedoanalgesia procedures, and the second how to obtain the necessary training. A list of research questions was prepared, keywords defined and a literature search carried out to break down and summarise the available evidence. The results are presented in the form of conclusions, which were subjected to anonymous voting by each of the members of the working group. For each of the conclusions, we provide the percent agreement obtained in the voting.
Topics: Humans; Child; Conscious Sedation; Analgesia; Pain Management; Emergency Service, Hospital; Pain
PubMed: 36347802
DOI: 10.1016/j.anpede.2022.09.009 -
Deutsches Arzteblatt International Nov 2010
Topics: Adolescent; Analgesia; Child; Conscious Sedation; Humans; Pain; Patient Care Team; Risk Assessment
PubMed: 21116403
DOI: 10.3238/arztebl.2010.0785 -
Revista Brasileira de Enfermagem Dec 2019To identify the procedures considered painful and stressful by health professionals from a neonatal intensive care unit and check the measures of analgesia.
OBJECTIVE
To identify the procedures considered painful and stressful by health professionals from a neonatal intensive care unit and check the measures of analgesia.
METHOD
Descriptive exploratory quantitative study with 65 health professionals, from November 2016 to February 2017.
RESULTS
The procedures considered painful were removal of adhesives, vein, arterial and lumbar puncture, phlebotomy, and thoracic drainage. Oral suctioning, intravenous catheter removal and tracheal extubation were considered stressful. Fentanyl was the most cited pharmacological measure, and restraint and nonnutritive suction were the most used nonpharmacological measures.
CONCLUSION
Professionals were able to classify the painful and stressful procedures; however, low use of measures for analgesia was evidenced.
Topics: Adult; Analgesia; Female; Health Personnel; Humans; Infant, Newborn; Male; Middle Aged; Pain; Pain Management; Pain Measurement; Perception; Stress, Psychological
PubMed: 31851250
DOI: 10.1590/0034-7167-2018-0326 -
PloS One 2023Few data are available on the intensity of pain that women experience during the first five days after vaginal childbirth. Moreover, it is unknown if the use of...
BACKGROUND
Few data are available on the intensity of pain that women experience during the first five days after vaginal childbirth. Moreover, it is unknown if the use of neuraxial labor analgesia has any impact on the level of postpartum pain.
METHODS
We performed a retrospective cohort study based on chart review of all women who delivered vaginally at an urban teaching hospital between April 2017 and April 2019. The primary outcome was the area under the curve of pain score on numeric rating scale (NRS) documented in electronic medical records for five days postpartum (NRS-AUC5days). Secondary outcomes included peak NRS score, doses of oral and intravenous analgesics consumed during the first five days postpartum, and relevant obstetric outcomes. Logistic regression was used to examine the associations between the use of neuraxial labor analgesia and pain-related outcomes adjusting for potential confounders.
RESULTS
During the study period, 778 women (38.6%) underwent vaginal delivery with neuraxial analgesia and 1240 women (61.4%) delivered without neuraxial analgesia. Median (Interquartile range) of NRS-AUC5days was 0.17 (0.12-0.24) among women who received neuraxial analgesia and 0.13 (0.08-0.19) among women who did not (p<0.001). Women who received neuraxial analgesia were more likely to require the first- and second-line analgesics postpartum than women who did not: diclofenac (87.9% vs. 73.0%, p< 0.001, respectively); acetaminophen (40.7% vs. 21.0%, p< 0.001, respectively). The use of neuraxial labor analgesia was independently associated with increased odds of having NRS-AUC5days in the highest 20 percentile (adjusted odds ratio [aOR] 2.03; 95% confidence interval [CI] 1.55-2.65), having peak NRS ≥ 4 (aOR 1.54; 95% CI 1.25-1.91) and developing hemorrhoids during the postpartum hospitalization (aOR 2.13; 95% CI 1.41-3.21) after adjusting for relevant confounders.
CONCLUSION
Although women who used neuraxial labor analgesia had slightly higher pain scores and increased analgesic requirement during postpartum hospitalization, pain after vaginal childbirth was overall mild. The small elevation in the pain burden in neuraxial group does not seem to be clinically relevant and should not influence women's choice to receive labor analgesia.
Topics: Pregnancy; Humans; Female; Retrospective Studies; Acute Pain; Delivery, Obstetric; Analgesics; Analgesia; Analgesia, Obstetrical; Analgesia, Epidural; Labor Pain
PubMed: 37071650
DOI: 10.1371/journal.pone.0284106 -
Anesthesia and Analgesia Sep 2012Neuraxial drugs provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or... (Review)
Review
Neuraxial drugs provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improves analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by the addition of clonidine, ketamine, neostigmine, or tramadol to single-shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high-quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, in the second half of this review, we present preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial drugs with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation before adoption of new analgesics or preparations into routine clinical practice.
Topics: Age Factors; Analgesia; Analgesics; Animals; Apnea; Humans; Infant; Infant, Newborn; Injections, Spinal; Postoperative Complications; Research Design
PubMed: 22798528
DOI: 10.1213/ANE.0b013e31826253f2 -
Anesthesiology Apr 2022The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the...
BACKGROUND
The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the parturient. This prospective comparative study aimed to test the hypothesis that the gastric emptying fraction of a light meal would be reduced in parturients receiving epidural analgesia and with no labor analgesia compared with nonpregnant and pregnant women.
METHODS
Ten subjects were enrolled and tested in each group: nonpregnant women, term pregnant women, parturients with no labor analgesia, and parturients with epidural labor analgesia. After a first ultrasound examination was performed to ensure an empty stomach, each subject ingested a light meal (125 g yogurt; 120 kcal) within 5 min. Then ultrasound measurements of the antral area were performed at 15, 60, 90, and 120 min. The fraction of gastric emptying at 90 min was calculated as [(antral area90 min / antral area15 min) - 1] × 100, and half-time to gastric emptying was also determined. For the Parturient-Epidural group, the test meal was ingested within the first hour after the induction of epidural analgesia.
RESULTS
The median (interquartile range) fraction of gastric emptying at 90 min was 52% (46 to 61), 45% (31 to 56), 7% (5 to 10), and 31% (17 to 39) for nonpregnant women, pregnant women, parturients without labor analgesia, and parturients with labor epidural analgesia, respectively (P < 0.0001). The fraction of gastric emptying at 90 min was statistically significant and lower in the Parturient-Epidural group than in the Nonpregnant and Pregnant Control groups. In addition, the fraction of gastric emptying at 90 min was statistically significant and lower in the Parturient-No-Epidural group than in the Parturient-Epidural group.
CONCLUSIONS
Gastric emptying in parturients after a light meal was delayed, and labor epidural analgesia seems not to worsen but facilitates gastric emptying. This should be taken into consideration when allowing women in labor to consume a light meal.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Analgesics; Female; Gastric Emptying; Humans; Labor, Obstetric; Pregnancy; Prospective Studies
PubMed: 35103759
DOI: 10.1097/ALN.0000000000004133 -
Annals of Palliative Medicine Oct 2015Bone marrow examination plays a crucial role in the diagnosis and management of various hematological and systemic diseases. Even though the procedure has been carried... (Review)
Review
Bone marrow examination plays a crucial role in the diagnosis and management of various hematological and systemic diseases. Even though the procedure has been carried out for decades, it remains an extremely painful and uncomfortable experience for a majority of patients. This paper reviews the different strategies used to provide analgesia and summarizes the advantages and drawbacks of one strategy over the other. A literature review was carried out addressing the different approaches to providing pain relief during bone marrow aspiration and biopsy. Several different methods, procedure modifications and protocols are employed at various centers but pain control and analgesia remain incomplete. Local infiltration with lidocaine or similar local analgesics is the standard at most centers. Although there is limited data, there are several studies in literature demonstrating the pain relieving effects of different methods and drugs when used with local anesthetics. Sedation, usually using benzodiazepines, reduces anticipatory anxiety, provides analgesia and also short term amnesia. Combinations of different agents not only yield potent effects but also reduce the required dose of each individual drug, minimizing adverse effects. Non-pharmacological factors also play key roles. Providing patients with complete and comprehensible information is vital to ensure the least amount of discomfort during the biopsy. Distraction techniques, such as cognitive behavioral therapy, hypnosis and music therapy, may also play a role in minimizing pain.
Topics: Analgesia; Biopsy; Bone Marrow; Bone Marrow Examination; Humans; Pain Management
PubMed: 26541397
DOI: 10.3978/j.issn.2224-5820.2015.09.02 -
The Journal of Pain Dec 2019Placebo analgesia is a robust phenomenon readily observed in both experimental and clinical settings. While researchers have begun to unpack its psychobiological... (Randomized Controlled Trial)
Randomized Controlled Trial
Placebo analgesia is a robust phenomenon readily observed in both experimental and clinical settings. While researchers have begun to unpack its psychobiological mechanisms, important questions remain regarding how we can capitalize on the placebo effect to improve clinical pain outcomes. The current study tested whether providing individuals with instrumental control-that is, control over if and when they administer a treatment-is capable of enhancing placebo analgesia. Using an established electrocutaneous pain design, 87 healthy volunteers either received placebo conditioning with instrumental control over treatment administration, standard passive placebo conditioning without any control over treatment administration, or were allocated to natural history control group with no conditioning and were later tested at equivalent shock intensity with and without placebo applied. Both placebo groups demonstrated initial placebo analgesia. Importantly, however, those provided with instrumental control demonstrated significantly larger and longer lasting placebo analgesia as well as reduced anticipatory autonomic arousal than those receiving standard passive placebo conditioning. This suggests that providing instrumental control over treatment administration can facilitate placebo analgesia by enhancing its magnitude and durability. As such, providing instrumental control over treatment administration may be a cheap and ethical method of using the placebo effect to improve clinical pain outcomes. PERSPECTIVE: Placebo research typically involves passive designs where individuals have no control over treatment administration. We present novel data demonstrating that providing control over treatment administration substantially enhances both the magnitude and duration of placebo analgesia. As such, where possible, providing control may improve clinical pain outcomes via the placebo effect.
Topics: Adult; Analgesia, Patient-Controlled; Female; Humans; Male; Motivation; Placebo Effect; Transcutaneous Electric Nerve Stimulation; Young Adult
PubMed: 31150780
DOI: 10.1016/j.jpain.2019.05.013 -
Journal of Clinical Anesthesia 1993
Topics: Analgesia; Analgesia, Patient-Controlled; Clinical Trials as Topic; Humans; Injections, Intramuscular; Meta-Analysis as Topic; Research Design; Statistics as Topic
PubMed: 8318236
DOI: 10.1016/0952-8180(93)90012-4 -
BJOG : An International Journal of... Feb 2015Approximately 60% of women who labour in the USA receive some form of neuraxial analgesia, but concerns have been raised regarding whether it negatively impacts the... (Review)
Review
Approximately 60% of women who labour in the USA receive some form of neuraxial analgesia, but concerns have been raised regarding whether it negatively impacts the labour and delivery process. In this review, we attempt to clarify what has been established as truths, falsities and uncertainties regarding the effects of this form of pain relief on labour progression, negative and/or positive. Additionally, although the term 'epidural' has become synonymous with neuraxial analgesia, we discuss two other techniques, combined spinal-epidural and continuous spinal analgesia, that are gaining popularity, as well as their effects on labour progression.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Delivery, Obstetric; Dystocia; Female; Humans; Labor Pain; Labor, Obstetric; Pain Measurement; Parturition; Patient Satisfaction; Pregnancy; Treatment Outcome
PubMed: 25088476
DOI: 10.1111/1471-0528.12966