Logo

Children very often experience multiple painful procedures in the course of their emergency department visit, as a part of investigation and treatment. The pain associated with these procedures can cause both long and short-term sequelae. Minimizing procedure-related pain should be a routine part of emergency department care for children.

BROWSE INFORMATiON REPOSITORY

 

 
 
Bottom Line Recommendations English (7) French (1) All (8)

Bottom Line: Application of topical local anesthetic for potentially painful skin-breaking procedures

Visit

Alberta Health Services

Objectives: To provide direction to health care professionals on the timely and safe application of topical local anesthetics prior to a painful skin-breaking procedure for in-patients and outpatients.

Bottom Line: Acute Procedural Pain: Paediatric Recommendations and Implementation Toolkits

Visit

The Canadian Association of Paediatric Health Centres, Knowledge Exchange Net...

Objective: This overview is intended to summarize the systematic reviews of interventions studied to decrease paediatric pain that are currently available in the Cochrane Library. Given their unique physiology, research relevant to the management of newborns in the first month of life is not reviewed here. Four reviews relevant to the management of childrens pain are currently available

UNDER REVIEW Bottom Line Recommendations: Procedural Pain

Download

Ali, S, Drendel A & TREKK Network

Bottom line recommendations for the treatment and management of procedural pain. Published online: November 2016.

Bottom Line: An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond. Pediatr Emerg Care 2016;32(1):36-42.

Visit

Ali S, McGrath T, Drendel AL

Objective: This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in the ED and beyond.

Bottom Line: Pain Ease(R): Topical anesthetic skin refrigerant (for children 4 years and older)

Visit

BC Children's Hospital

Purpose: Pain Ease spray is a vapocoolant (skin refrigerant) intended for topical application to skin and minor open wounds. It controls pain associated with injections (venipunctures, IV start) and minor surgical procedures (eg. irrigating laceration/abrasions).

Bottom Line: Psychological Interventions

Visit

BC Children's Hospital

Even with sedation, the success of a procedure is equally reliant upon careful consideration of psychosocial aspects as it is reliant on physical aspects. A sense of mastery and control experienced by parents and children is crucial to their confidence in managing any future procedures. Reducing both pain and anxiety will facilitate effective coping.

Bottom Line: Sucrose as a procedural analgesic for infants up to 12 monts of age

Visit

BC Children's Hospital

Purpose: Oral sucrose and other sweet tasting solutions have been used for management of pain in infants for centuries. Studies done since the early 1990's have demonstrated that the administration of sucrose and non-nutritive sucking are effective non-pharmacological interventions for relief of procedural pain in neonates and infants and may help reduce pain in infants up to 12 months of age. Sucrose and non-nutritive sucking are thought to elevate pain thresholds via endogenous opioid pathways.

UNDER REVIEW: Recommandations de Base: Douleur procdurale

Download

French Bottom line recommendations for the treatment and management of procedural pain. Published online: March 2017.

Bottom Line: Application of topical local anesthetic for potentially painful skin-breaking procedures

Visit

Alberta Health Services

Objectives: To provide direction to health care professionals on the timely and safe application of topical local anesthetics prior to a painful skin-breaking procedure for in-patients and outpatients.

Bottom Line: Acute Procedural Pain: Paediatric Recommendations and Implementation Toolkits

Visit

The Canadian Association of Paediatric Health Centres, Knowledge Exchange Net...

Objective: This overview is intended to summarize the systematic reviews of interventions studied to decrease paediatric pain that are currently available in the Cochrane Library. Given their unique physiology, research relevant to the management of newborns in the first month of life is not reviewed here. Four reviews relevant to the management of childrens pain are currently available

UNDER REVIEW: Recommandations de Base: Douleur procdurale

Download

French Bottom line recommendations for the treatment and management of procedural pain. Published online: March 2017.

UNDER REVIEW Bottom Line Recommendations: Procedural Pain

Download

Ali, S, Drendel A & TREKK Network

Bottom line recommendations for the treatment and management of procedural pain. Published online: November 2016.

Bottom Line: An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond. Pediatr Emerg Care 2016;32(1):36-42.

Visit

Ali S, McGrath T, Drendel AL

Objective: This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in the ED and beyond.

Bottom Line: Pain Ease(R): Topical anesthetic skin refrigerant (for children 4 years and older)

Visit

BC Children's Hospital

Purpose: Pain Ease spray is a vapocoolant (skin refrigerant) intended for topical application to skin and minor open wounds. It controls pain associated with injections (venipunctures, IV start) and minor surgical procedures (eg. irrigating laceration/abrasions).

Bottom Line: Psychological Interventions

Visit

BC Children's Hospital

Even with sedation, the success of a procedure is equally reliant upon careful consideration of psychosocial aspects as it is reliant on physical aspects. A sense of mastery and control experienced by parents and children is crucial to their confidence in managing any future procedures. Reducing both pain and anxiety will facilitate effective coping.

Bottom Line: Sucrose as a procedural analgesic for infants up to 12 monts of age

Visit

BC Children's Hospital

Purpose: Oral sucrose and other sweet tasting solutions have been used for management of pain in infants for centuries. Studies done since the early 1990's have demonstrated that the administration of sucrose and non-nutritive sucking are effective non-pharmacological interventions for relief of procedural pain in neonates and infants and may help reduce pain in infants up to 12 months of age. Sucrose and non-nutritive sucking are thought to elevate pain thresholds via endogenous opioid pathways.

Clinical guidelines English (9) French All (9)

Clinical Practice Guideline: Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures.

Visit

Trottier ED,Dor-Bergeron MJ,Chauvin-Kimoff L,Baerg K,Ali S.

Purpose: This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures

Clinical Practice Guideline: Pain-Less Practice: Techniques to Reduce Procedural Pain and Anxiety in Pediatric Acute Care

Visit

Olsen, K, Weinberg, E

Purpose: This article introduces the concept of a PainLESS Practicean evidence-based, tiered approach to procedural pain and anxiety management in acute care

Clincal Practice Guideline: Prevention and Management of Procedural Pain in the Neonate: An Update

Visit

Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine

Purpose: This statement updates previous recommendations with new evidence on the prevention, assessment, and treatment of neonatal procedural pain.

Video: Managing Procedural Anxiety in Children

Visit

Krauss BS, Krauss BA, Green SM.

This video describes the signs of acute anxiety in children and demonstrates approaches to interacting with children that minimize anxiety and maximize cooperation. Published: April 2016.

Clinical Practice Guideline: Good practice in postoperative and procedural pain management

Visit

Association of Paediatric Anaesthetists of Great Britain and Ireland

This themed issue starts with an outstanding review of the history of Pediatric Regional Anesthesia (PRA), written by an equally outstanding second-wave pioneer and promoter of this particular facet of pediatric anesthesia, Professor Emeritus Kester Brown.

Clincial Practive Guideline: Premedication for endotracheal intubation in the newborn infant

Visit

KJ Barrington, Canadian Paediatric Society, Fetus and Newborn Committee

Based on current evidence, an optimal protocol for premedication is to administer a vagolytic (intravenous [IV] atropine 20 g/kg), a rapid-acting analgesic (IV fentanyl 3 g/kg to 5 g/kg; slow infusion) and a short-duration muscle relaxant (IV succinylcholine 2 mg/kg). Intubations should be performed or supervised by trained staff, with close monitoring of the infant throughout.

Clinical Practice Guideline: Evidenced-based clinical practice guideline for management of newborn pain

Visit

Spence K, Henderson-Smart D, New K, Evans C, Whitelaw J, Woolnough R

Aim: To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline.

Clinical Practice Guideline: Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline

Visit

Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan...

Our objective was to develop a clinical practice guideline, based on systematic reviews of the literature, as interpreted by experts, to assist clinicians in managing procedure-related pain and distress among children undergoing vaccine injections.

Clinical Practice Guideline: The recognition and assessment of acute pain in children

Visit

Royal College of Nursing

The guideline is aimed at a range of professional groups, patients and carers who may be involved in the assessment and management of childrens pain. The primary aims of this guideline are to: identify reliable and valid measures of pain intensity appropriate for neonates and preverbal infants, and verbal and non-verbal children, through a systematic search and appraisal of the literature; describe these tools to help practitioners select from these in different clinical settings; and make recommendations regarding timing and triggers for formal pain assessment.

Clinical Practice Guideline: Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures.

Visit

Trottier ED,Dor-Bergeron MJ,Chauvin-Kimoff L,Baerg K,Ali S.

Purpose: This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures

Clinical Practice Guideline: Pain-Less Practice: Techniques to Reduce Procedural Pain and Anxiety in Pediatric Acute Care

Visit

Olsen, K, Weinberg, E

Purpose: This article introduces the concept of a PainLESS Practicean evidence-based, tiered approach to procedural pain and anxiety management in acute care

Clincal Practice Guideline: Prevention and Management of Procedural Pain in the Neonate: An Update

Visit

Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine

Purpose: This statement updates previous recommendations with new evidence on the prevention, assessment, and treatment of neonatal procedural pain.

Video: Managing Procedural Anxiety in Children

Visit

Krauss BS, Krauss BA, Green SM.

This video describes the signs of acute anxiety in children and demonstrates approaches to interacting with children that minimize anxiety and maximize cooperation. Published: April 2016.

Clinical Practice Guideline: Good practice in postoperative and procedural pain management

Visit

Association of Paediatric Anaesthetists of Great Britain and Ireland

This themed issue starts with an outstanding review of the history of Pediatric Regional Anesthesia (PRA), written by an equally outstanding second-wave pioneer and promoter of this particular facet of pediatric anesthesia, Professor Emeritus Kester Brown.

Clincial Practive Guideline: Premedication for endotracheal intubation in the newborn infant

Visit

KJ Barrington, Canadian Paediatric Society, Fetus and Newborn Committee

Based on current evidence, an optimal protocol for premedication is to administer a vagolytic (intravenous [IV] atropine 20 g/kg), a rapid-acting analgesic (IV fentanyl 3 g/kg to 5 g/kg; slow infusion) and a short-duration muscle relaxant (IV succinylcholine 2 mg/kg). Intubations should be performed or supervised by trained staff, with close monitoring of the infant throughout.

Clinical Practice Guideline: Evidenced-based clinical practice guideline for management of newborn pain

Visit

Spence K, Henderson-Smart D, New K, Evans C, Whitelaw J, Woolnough R

Aim: To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline.

Clinical Practice Guideline: Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline

Visit

Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan...

Our objective was to develop a clinical practice guideline, based on systematic reviews of the literature, as interpreted by experts, to assist clinicians in managing procedure-related pain and distress among children undergoing vaccine injections.

Clinical Practice Guideline: The recognition and assessment of acute pain in children

Visit

Royal College of Nursing

The guideline is aimed at a range of professional groups, patients and carers who may be involved in the assessment and management of childrens pain. The primary aims of this guideline are to: identify reliable and valid measures of pain intensity appropriate for neonates and preverbal infants, and verbal and non-verbal children, through a systematic search and appraisal of the literature; describe these tools to help practitioners select from these in different clinical settings; and make recommendations regarding timing and triggers for formal pain assessment.

Summaries of systematic reviews English (11) French All (11)

Cochrane Summary: Psychological interventions for needle-related procedural pain and distress in children and adolescents

Visit

Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA

To assess the efficacy of psychological interventions for needlerelated procedural pain and distress in children and adolescents.

Cochrane Summary: Local anaesthesia (numbing medicine) that is directly applied to the skin can provide pain control for repair of skin lacerations

Visit

Tayeb BO, Eidelman A, Eidelman CL, McNicol ED, Carr DB

To assess whether benefits of noninvasive topical anaesthetic application occur at the expense of decreased analgesic efficacy. To compare the efficacy of various singlecomponent or multicomponent topical anaesthetic agents for repair of dermal lacerations. To determine the clinical necessity for topical application of the ester anaesthetic, cocaine.

Cochrane Summary: Skin-to-skin care with newborns cuts down procedural pain

Visit

Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, Ingl...

The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonates

Cochrane Summary: Sucrose for analgesia in newborn infants undergoing painful procedures

Visit

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A

The secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants.

Cochrane Summary: Sweet taste to ease injection needle pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

This is an updated version of the original Cochrane review published in Issue 10, 2011: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. We re-ran the search in October 2014. Review question: Do sweet tasting solutions reduce pain during needles in children aged from one to 16 years, compared to no treatment, water, other non-sweet solutions, or other interventions such as non-nutritive sucking (babies) or sweet foods or chewing gum (children), topical anaesthetics, music, and distraction? Background: Small amounts of sweet tasting sugar solutions given orally to babies before and during painful needles significantly reduces distress. However it was not known if the same pain-reducing effects of sweet solutions occurred in children older than one year of age. We therefore examined studies looking at pain-reducing effects of sweet solutions such as sucrose or glucose for painful needle procedures in children aged one to 16 years. Search date: We searched the literature for published and unpublished studies up to October 2014. Study characteristics: We found six studies focused on young children aged one to four years; two of these studies were included in the original review and four were new studies. The two studies included in the original review used a low concentration of sucrose, just 12%, which is not considered sweet enough for the pain reducing effects. Three of the four new studies were small pilot studies, conducted to inform full trials, and only one study of sweet solutions in young children included large numbers of children. When we compared results of all six studies, only two showed that sugar water (sucrose) reduced pain during injections. However, the four studies that showed no effect all included small numbers of children, therefore they were not considered large enough to detect significant differences in pain. Further well conducted trials with large enough numbers of young children are needed to work out if sweet taste effectively reduces their pain and distress during needles. For older school-aged children, there were two studies published by the same author, both of which were included in the original review. Neither study showed that sweet taste helped to reduce pain. As other studies show that strategies such as distraction and topical anaesthetics can effectively reduce needle pain in school-aged children, further studies of sweet taste for pain management in school-aged children are not warranted. Study funding sources: Of the six studies including young children, two did not acknowledge receipt of research funding. For the remaining four: a state-wide nursing fund supported two of the pilot studies, an internal research institute provided support for the remaining pilot study and another study was supported in part by a Maternal and Child Health grant. The two studies including school-aged children, conducted by the same author, were supported by a grant from the Canadian Institutes of Health Research.

Cochrane Summary: Nonpharmacological management of infant and young child procedural pain

Visit

Pillai Riddell RR, Racine NM, Gennis HG, Turcotte K, Uman LS, Horton RE, Ahol...

We examined 13 different types of commonly investigated non-pharmacological treatments (excluding breastmilk, sucrose, and music) to determine theirefficacyfor pain reactions after an acutely painful procedure (right after the needle ('pain reactivity') and less immediate pain reactions ('immediate pain-related regulation').Fifty-onerandomizedcontrolled trials were included involving 3396 participants. For preterm infants, there was sufficient evidence to recommend kangaroo care, sucking-related interventions, and swaddling/facilitated tucking interventions for both pain reactivity and immediate pain-related regulation. For neonates, there was sufficient evidence to recommend sucking-related interventions as an effective treatment for pain reactivity and immediate pain-related regulation.Rocking/holding was also found to be efficacious for neonatal immediate pain-related regulation.For older infants, there were no treatments reviewed that demonstrated sufficient evidence. Due to significant differences in the magnitude of treatment effects among studies (heterogeneity), some analyses that found a lack of treatment effect need to be interpreted with caution.

Cochrane Summary: Sweet-tasting solutions for needle-related pain in infants up to one year of age

Visit

Kassab M, Foster JP, Foureu M, Fowle C

The use of needles that break the skin and cause pain is a common practice around the world with babies aged between one month and 12 months (Appendix 4). In thisreviewwe were interested in whether giving babies sugar-based solutions to taste when the needle breaks the skin will help reduce their pain. We found 14 separate studies that had asked this question. However, the differences between the studies were often too great to let us combine their findings. Overall, the studies show that different types of sugar-based solutions were effective but we were not able to confidently assert that there is strong evidence for this treatment in reducing pain. We did find some evidence that babies may not cry for as long if given sugar-based solutions. Thisreviewis broadly in agreement with two other reviews, one asking this question in younger children, and one in older children. There is a need for better studies in this field.

Cochrane Overview: The Cochrane Library and procedural pain in children: an overview of reviews

Visit

Curtis S, Wingert A, Ali S

Objective: To summarize Cochrane reviews assessing the effects of various interventions used for pain in non-neonatal children undergoing painful medical procedures.

Cochrane Summary: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Breastfeeding provides pain relief for newborn babies undergoing painful procedures. Medicine for pain relief is commonly given for major painful procedures, but may not be given for minor painful procedures such as blood sampling (by heel prick orvenepuncture). There are different forms of non-pharmacological strategies that may be used to reduce pain in babies, such as holding, swaddling them, sucking on a pacifier, or giving sweet solutions (such as sucrose or glucose). Different studies done in babies have shown that breastfeeding is a good way to reduce the pain babies feel when subjected to minor painful procedures. These studies have been done in full-term babies and they have shown that breastfeeding is effective by demonstrating that it reduces babies' crying time and reduces different pain scores that have been validated for babies. Breast milk given by syringe has not shown the sameefficacyas breastfeeding itself. No studies have been done in premature babies, and so new studies are needed to determine if the use of supplemental breast milk in these small babies is effective in reducing their pain.

Cochrane Summary: Venepuncture versus heel lance for blood sampling in term neonates

Visit

Shah V, Ohlsson A

In most countries, a blood sample from newborn babies is needed forscreeningtests. A heel lance is the standard way of taking blood, but it is a painful procedure with no optimal method of pain relief known. Thisreviewof trials found evidence thatvenepuncture, when done by a trained practitioner, caused less pain than heel lance. The use of a sweet tasting solution given to the baby prior to the event reduced pain further. The evidence includedoutcomemeasures using pain scales, how long the baby cried and how the mother rated their baby's pain.

Cochrane Summary: Tissue adhesives for traumatic lacerations in children and adults

Visit

Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N

Cuts (lacerations) often need to be closed to ensure proper healing, and prevent infection or unattractivescarring. Wounds may be closed with stitches (sutures), staples, tapes or glue (tissueadhesive). Thereviewfound that glue is an excellent substitute for stitches, staples or tapes to close simple cuts. Glue causes less pain, is quicker and needs no follow up for removal. A slightly higher number of cuts may break open (dehisce) after being glued, compared to cuts closed with stitches, staples or tapes. Though there are a few different types of glue available, no one glue seems to be superior.

Cochrane Summary: Psychological interventions for needle-related procedural pain and distress in children and adolescents

Visit

Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA

To assess the efficacy of psychological interventions for needlerelated procedural pain and distress in children and adolescents.

Cochrane Summary: Local anaesthesia (numbing medicine) that is directly applied to the skin can provide pain control for repair of skin lacerations

Visit

Tayeb BO, Eidelman A, Eidelman CL, McNicol ED, Carr DB

To assess whether benefits of noninvasive topical anaesthetic application occur at the expense of decreased analgesic efficacy. To compare the efficacy of various singlecomponent or multicomponent topical anaesthetic agents for repair of dermal lacerations. To determine the clinical necessity for topical application of the ester anaesthetic, cocaine.

Cochrane Summary: Skin-to-skin care with newborns cuts down procedural pain

Visit

Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, Ingl...

The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonates

Cochrane Summary: Sucrose for analgesia in newborn infants undergoing painful procedures

Visit

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A

The secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants.

Cochrane Summary: Sweet taste to ease injection needle pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

This is an updated version of the original Cochrane review published in Issue 10, 2011: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. We re-ran the search in October 2014. Review question: Do sweet tasting solutions reduce pain during needles in children aged from one to 16 years, compared to no treatment, water, other non-sweet solutions, or other interventions such as non-nutritive sucking (babies) or sweet foods or chewing gum (children), topical anaesthetics, music, and distraction? Background: Small amounts of sweet tasting sugar solutions given orally to babies before and during painful needles significantly reduces distress. However it was not known if the same pain-reducing effects of sweet solutions occurred in children older than one year of age. We therefore examined studies looking at pain-reducing effects of sweet solutions such as sucrose or glucose for painful needle procedures in children aged one to 16 years. Search date: We searched the literature for published and unpublished studies up to October 2014. Study characteristics: We found six studies focused on young children aged one to four years; two of these studies were included in the original review and four were new studies. The two studies included in the original review used a low concentration of sucrose, just 12%, which is not considered sweet enough for the pain reducing effects. Three of the four new studies were small pilot studies, conducted to inform full trials, and only one study of sweet solutions in young children included large numbers of children. When we compared results of all six studies, only two showed that sugar water (sucrose) reduced pain during injections. However, the four studies that showed no effect all included small numbers of children, therefore they were not considered large enough to detect significant differences in pain. Further well conducted trials with large enough numbers of young children are needed to work out if sweet taste effectively reduces their pain and distress during needles. For older school-aged children, there were two studies published by the same author, both of which were included in the original review. Neither study showed that sweet taste helped to reduce pain. As other studies show that strategies such as distraction and topical anaesthetics can effectively reduce needle pain in school-aged children, further studies of sweet taste for pain management in school-aged children are not warranted. Study funding sources: Of the six studies including young children, two did not acknowledge receipt of research funding. For the remaining four: a state-wide nursing fund supported two of the pilot studies, an internal research institute provided support for the remaining pilot study and another study was supported in part by a Maternal and Child Health grant. The two studies including school-aged children, conducted by the same author, were supported by a grant from the Canadian Institutes of Health Research.

Cochrane Summary: Nonpharmacological management of infant and young child procedural pain

Visit

Pillai Riddell RR, Racine NM, Gennis HG, Turcotte K, Uman LS, Horton RE, Ahol...

We examined 13 different types of commonly investigated non-pharmacological treatments (excluding breastmilk, sucrose, and music) to determine theirefficacyfor pain reactions after an acutely painful procedure (right after the needle ('pain reactivity') and less immediate pain reactions ('immediate pain-related regulation').Fifty-onerandomizedcontrolled trials were included involving 3396 participants. For preterm infants, there was sufficient evidence to recommend kangaroo care, sucking-related interventions, and swaddling/facilitated tucking interventions for both pain reactivity and immediate pain-related regulation. For neonates, there was sufficient evidence to recommend sucking-related interventions as an effective treatment for pain reactivity and immediate pain-related regulation.Rocking/holding was also found to be efficacious for neonatal immediate pain-related regulation.For older infants, there were no treatments reviewed that demonstrated sufficient evidence. Due to significant differences in the magnitude of treatment effects among studies (heterogeneity), some analyses that found a lack of treatment effect need to be interpreted with caution.

Cochrane Summary: Sweet-tasting solutions for needle-related pain in infants up to one year of age

Visit

Kassab M, Foster JP, Foureu M, Fowle C

The use of needles that break the skin and cause pain is a common practice around the world with babies aged between one month and 12 months (Appendix 4). In thisreviewwe were interested in whether giving babies sugar-based solutions to taste when the needle breaks the skin will help reduce their pain. We found 14 separate studies that had asked this question. However, the differences between the studies were often too great to let us combine their findings. Overall, the studies show that different types of sugar-based solutions were effective but we were not able to confidently assert that there is strong evidence for this treatment in reducing pain. We did find some evidence that babies may not cry for as long if given sugar-based solutions. Thisreviewis broadly in agreement with two other reviews, one asking this question in younger children, and one in older children. There is a need for better studies in this field.

Cochrane Overview: The Cochrane Library and procedural pain in children: an overview of reviews

Visit

Curtis S, Wingert A, Ali S

Objective: To summarize Cochrane reviews assessing the effects of various interventions used for pain in non-neonatal children undergoing painful medical procedures.

Cochrane Summary: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Breastfeeding provides pain relief for newborn babies undergoing painful procedures. Medicine for pain relief is commonly given for major painful procedures, but may not be given for minor painful procedures such as blood sampling (by heel prick orvenepuncture). There are different forms of non-pharmacological strategies that may be used to reduce pain in babies, such as holding, swaddling them, sucking on a pacifier, or giving sweet solutions (such as sucrose or glucose). Different studies done in babies have shown that breastfeeding is a good way to reduce the pain babies feel when subjected to minor painful procedures. These studies have been done in full-term babies and they have shown that breastfeeding is effective by demonstrating that it reduces babies' crying time and reduces different pain scores that have been validated for babies. Breast milk given by syringe has not shown the sameefficacyas breastfeeding itself. No studies have been done in premature babies, and so new studies are needed to determine if the use of supplemental breast milk in these small babies is effective in reducing their pain.

Cochrane Summary: Venepuncture versus heel lance for blood sampling in term neonates

Visit

Shah V, Ohlsson A

In most countries, a blood sample from newborn babies is needed forscreeningtests. A heel lance is the standard way of taking blood, but it is a painful procedure with no optimal method of pain relief known. Thisreviewof trials found evidence thatvenepuncture, when done by a trained practitioner, caused less pain than heel lance. The use of a sweet tasting solution given to the baby prior to the event reduced pain further. The evidence includedoutcomemeasures using pain scales, how long the baby cried and how the mother rated their baby's pain.

Cochrane Summary: Tissue adhesives for traumatic lacerations in children and adults

Visit

Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N

Cuts (lacerations) often need to be closed to ensure proper healing, and prevent infection or unattractivescarring. Wounds may be closed with stitches (sutures), staples, tapes or glue (tissueadhesive). Thereviewfound that glue is an excellent substitute for stitches, staples or tapes to close simple cuts. Glue causes less pain, is quicker and needs no follow up for removal. A slightly higher number of cuts may break open (dehisce) after being glued, compared to cuts closed with stitches, staples or tapes. Though there are a few different types of glue available, no one glue seems to be superior.

Systematic reviews English (26) French All (26)

Systematic Review: Digital Technology Distraction for Acute Pain in Children: AMeta-analysis

Visit

Michelle Gates,Lisa Hartling,Jocelyn Shulhan-Kilroy,Tara MacGregor,Samantha G...

Objective:To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures.

Cochrane Systematic Review: Psychological interventions for needlerelated procedural pain and distress in children and adolescents

Visit

BirnieKA, NoelM, ChambersCT, UmanLS, ParkerJA

Objectives: To provide an update to our 2006 review assessing the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.

Systematic Review: Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: A meta-analysis of randomized controlled trials.

Visit

Zhu Y,Peng X,Wang S,Chen W,Liu C,Guo B,Zhao L,Gao Y,Wang K,Lou F.

Objectives:The objective of our meta-analysis is to compare the effectiveness of vapocoolant spray and placebo spray/no treatment for pain reduction during intravenous cannulation.

Systematic Review: Clinical efficacy of virtual reality for acute procedural pain management: A systematic review and meta-analysis

Visit

Evelyn Chan, Samantha Foster , Ryan Sambell , Paul Leong

There is no comprehensive, high-quality systematic review that specifically assesses the efficacy of virtual reality on acutely painful healthcare interventions, nor has there been any quantitative data synthesis on this topic. We therefore conducted a systematic review and meta analysis to appraise the quality of published literature and to synthesize data for acute pain scores.

Cochrane Systematic Review: Topical anaesthetics for pain control during repair of dermal laceration

Visit

TayebBO, EidelmanA, EidelmanCL, McNicolED, CarrDB

Objectives: To compare the efficacy and safety of infiltrated local anaesthetics with those of topical local anaesthetics for repair of dermal lacerations and to evaluate the efficacy and safety of various single or multi-component topical anaesthetics to identify cocaine-free topically applied local anaesthetics that may provide equivalent analgesia to those containing cocaine.

Systematic Review: LidocaineGelforUrethralCatheterizationinChildren: AMeta-Analysis.

Visit

Chua ME,Firaza PNB,Ming JM,Silangcruz JMA,Braga LH,Lorenzo AJ

Objective:To compare the efficacy and safety of lidocaine gel vs nonanesthetic gel (NAG) in reducing transurethral bladder catheterization (TUBC) procedural pain in children.

Systematic Review: What is theBestPain ManagementDuringGastricTubeInsertionforInfantsAged0-12months: ASystematic Review.

Visit

Chen S,Zhang Q,Xie RH,Wen SW,Harrison D

Synthesized evidence on the effectiveness of pain management for nasogastric tube (NGT) and orogastric tube (OGT) insertions in infants is lacking. This paper is a systematic review of the effectiveness of pain management for gastric tube (GT) insertion in infants.

Systematic Review: Sweet Solutions to Reduce Procedural Pain in Neonates: AMeta-analysis

Visit

Denise Harrison,Catherine Larocque,Mariana Bueno,Yehudis Stokes,Lucy Turner,B...

Objective: To review all trials evaluating sweet solutions for analgesia in neonates and to conduct cumulative meta-analyses (CMAs) on behavioral pain outcomes.

Cochrane Systematic Review: Sucrose for analgesia in newborn infants undergoing painful procedures

Visit

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A

Objective: To determine the efficacy, effect of dose and safety of oral sucrose for relieving procedural pain in neonates.

Cochrane Systematic Review: Breastfeeding for procedural pain in infants beyond the neonatal period

Visit

Harrison D, Reszel J, Bueno M, et al.

Objectives:To determine the effect of breastfeeding on procedural pain in infants beyond the neonatal period (first 28 days of life) up to one year of age compared to no intervention, placebo, parental holding, skin-to-skin contact, expressed breast milk, formula milk, bottle feeding, sweet-tasting solutions (e.g. sucrose or glucose), distraction, or other interventions.

Cochrane Systematic Review: Nonpharmacological management of infant and young child procedural pain

Visit

Pillai RiddellRR, RacineNM, GennisHG, TurcotteK, UmanLS, HortonRE, Ahola Kohu...

Objectives: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Systematic Review: A systematic review of vapocoolants for reducing pain from venipuncture and venous cannulation in children and adults

Visit

Hogan ME, Smart S, Shah V, Taddio A

Our aim was to systematically review the literature regarding the analgesic effectiveness of vapocoolants in children and adults.

Systematic Review: Pediatric clinical practice guidelines for acute procedural pain: a systematic review

Visit

Lee GY, Yamada J, Kyololo O, Shorkey A, Stevens B

Objective: To systematically review the quality of existing practice guidelines for acute procedural pain in children and provide recommendations for their use.

Review: Relief of pain and anxiety in pediatric patients in emergency medical systems

Visit

Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Cochrane Systematic Review: Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age

Visit

Kassab M, Foster JP, Foureur M, Fowler C

Objectives: To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods.

Cochrane Systematic Review: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Objectives: The primary objective was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, gestational age and the amount of supplemental breast milk given.

Cochrane Systematic Review: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

Objectives: To determine the efficacy of sweet tasting solutions or substances for reducing needle-related procedural pain in children beyond one year of age.

Cochrane Systematic Review: Non-pharmacological management of infant and young child procedural pain

Visit

Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ah...

Objectives: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Systematic Review: The effectiveness of virtual reality distraction for pain reduction:a systematic review

Visit

Kevin M Malloy , Leonard S Milling

This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain.

Systematic Review: Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials

Visit

Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L

Objective: The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures.

Review: Clinical implications of unmanaged needle-insertion pain and distress in children

Visit

Kennedy RM, Luhmann J, Zempsky WT

This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.

Review: Needle pain in children: contextual factors

Visit

Walco GA

Pediatric pain experiences result from a complex interplay of genetic, experiential, and developmental factors. These elements, as they relate to needle-stick procedures and other relevant painful phenomena, are explored in this article so that the context of possible interventions may be more fully appreciated. Clinical implications are discussed incorporating ethical perspectives.

Review: Pharmacologic approaches for reducing venous access pain in children

Visit

Zempsky WT

A variety of pharmacologic options are available to clinicians who want to provide effective and safe topical local anesthesia to children undergoing venous access procedures. These options can be distinguished on the basis of how they deliver active drug through the impermeable outer layer of skin, the stratum corneum, to pain receptors located in the dermis and epidermis. Three general methodologies are typically used to bypass the stratum corneum: direct injection of local anesthetics, usually via a small-gauge hypodermic syringe; passive diffusion from topical creams or gels; and active needle-free drug strategies that enhance the rate of drug passage into the dermis and epidermis.

Cochrane Systematic Review: Venepuncture versus heel lance for blood sampling in term neonates

Visit

Shah V, Ohlsson A

Objectives: To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates.

Systematic Review: Theroleofparentalpresencein thecontextofchildren'smedicalprocedures: asystematic review.

Visit

Piira T,Sugiura T,Champion GD,Donnelly N,Cole AS

There are conflicting views and practices regarding whether or not parents should be present at the time of their child's medical procedure. A systematic review was conducted to assess the effects of parental presence in the paediatric treatment room on child, parent and health professional outcomes and to synthesize this body of literature.

Cochrane Systematic Review: To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates

Visit

Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N

Objectives: To summarize the best available evidence for the effect of tissue adhesives in the management of traumatic lacerations in children and adults.

Systematic Review: Digital Technology Distraction for Acute Pain in Children: AMeta-analysis

Visit

Michelle Gates,Lisa Hartling,Jocelyn Shulhan-Kilroy,Tara MacGregor,Samantha G...

Objective:To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures.

Cochrane Systematic Review: Psychological interventions for needlerelated procedural pain and distress in children and adolescents

Visit

BirnieKA, NoelM, ChambersCT, UmanLS, ParkerJA

Objectives: To provide an update to our 2006 review assessing the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.

Systematic Review: Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: A meta-analysis of randomized controlled trials.

Visit

Zhu Y,Peng X,Wang S,Chen W,Liu C,Guo B,Zhao L,Gao Y,Wang K,Lou F.

Objectives:The objective of our meta-analysis is to compare the effectiveness of vapocoolant spray and placebo spray/no treatment for pain reduction during intravenous cannulation.

Systematic Review: Clinical efficacy of virtual reality for acute procedural pain management: A systematic review and meta-analysis

Visit

Evelyn Chan, Samantha Foster , Ryan Sambell , Paul Leong

There is no comprehensive, high-quality systematic review that specifically assesses the efficacy of virtual reality on acutely painful healthcare interventions, nor has there been any quantitative data synthesis on this topic. We therefore conducted a systematic review and meta analysis to appraise the quality of published literature and to synthesize data for acute pain scores.

Cochrane Systematic Review: Topical anaesthetics for pain control during repair of dermal laceration

Visit

TayebBO, EidelmanA, EidelmanCL, McNicolED, CarrDB

Objectives: To compare the efficacy and safety of infiltrated local anaesthetics with those of topical local anaesthetics for repair of dermal lacerations and to evaluate the efficacy and safety of various single or multi-component topical anaesthetics to identify cocaine-free topically applied local anaesthetics that may provide equivalent analgesia to those containing cocaine.

Systematic Review: LidocaineGelforUrethralCatheterizationinChildren: AMeta-Analysis.

Visit

Chua ME,Firaza PNB,Ming JM,Silangcruz JMA,Braga LH,Lorenzo AJ

Objective:To compare the efficacy and safety of lidocaine gel vs nonanesthetic gel (NAG) in reducing transurethral bladder catheterization (TUBC) procedural pain in children.

Systematic Review: What is theBestPain ManagementDuringGastricTubeInsertionforInfantsAged0-12months: ASystematic Review.

Visit

Chen S,Zhang Q,Xie RH,Wen SW,Harrison D

Synthesized evidence on the effectiveness of pain management for nasogastric tube (NGT) and orogastric tube (OGT) insertions in infants is lacking. This paper is a systematic review of the effectiveness of pain management for gastric tube (GT) insertion in infants.

Systematic Review: Sweet Solutions to Reduce Procedural Pain in Neonates: AMeta-analysis

Visit

Denise Harrison,Catherine Larocque,Mariana Bueno,Yehudis Stokes,Lucy Turner,B...

Objective: To review all trials evaluating sweet solutions for analgesia in neonates and to conduct cumulative meta-analyses (CMAs) on behavioral pain outcomes.

Cochrane Systematic Review: Sucrose for analgesia in newborn infants undergoing painful procedures

Visit

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A

Objective: To determine the efficacy, effect of dose and safety of oral sucrose for relieving procedural pain in neonates.

Cochrane Systematic Review: Breastfeeding for procedural pain in infants beyond the neonatal period

Visit

Harrison D, Reszel J, Bueno M, et al.

Objectives:To determine the effect of breastfeeding on procedural pain in infants beyond the neonatal period (first 28 days of life) up to one year of age compared to no intervention, placebo, parental holding, skin-to-skin contact, expressed breast milk, formula milk, bottle feeding, sweet-tasting solutions (e.g. sucrose or glucose), distraction, or other interventions.

Cochrane Systematic Review: Nonpharmacological management of infant and young child procedural pain

Visit

Pillai RiddellRR, RacineNM, GennisHG, TurcotteK, UmanLS, HortonRE, Ahola Kohu...

Objectives: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Systematic Review: A systematic review of vapocoolants for reducing pain from venipuncture and venous cannulation in children and adults

Visit

Hogan ME, Smart S, Shah V, Taddio A

Our aim was to systematically review the literature regarding the analgesic effectiveness of vapocoolants in children and adults.

Systematic Review: Pediatric clinical practice guidelines for acute procedural pain: a systematic review

Visit

Lee GY, Yamada J, Kyololo O, Shorkey A, Stevens B

Objective: To systematically review the quality of existing practice guidelines for acute procedural pain in children and provide recommendations for their use.

Review: Relief of pain and anxiety in pediatric patients in emergency medical systems

Visit

Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Cochrane Systematic Review: Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age

Visit

Kassab M, Foster JP, Foureur M, Fowler C

Objectives: To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared with no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods.

Cochrane Systematic Review: Breastfeeding or breast milk for procedural pain in neonates

Visit

Shah PS, Herbozo C, Aliwalas LL, Shah VS

Objectives: The primary objective was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, gestational age and the amount of supplemental breast milk given.

Cochrane Systematic Review: Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years

Visit

Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B

Objectives: To determine the efficacy of sweet tasting solutions or substances for reducing needle-related procedural pain in children beyond one year of age.

Cochrane Systematic Review: Non-pharmacological management of infant and young child procedural pain

Visit

Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ah...

Objectives: To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding breastmilk, sucrose, and music. Analyses accounted for infant age (preterm, neonate, older) and pain response (pain reactivity, pain-related regulation).

Systematic Review: The effectiveness of virtual reality distraction for pain reduction:a systematic review

Visit

Kevin M Malloy , Leonard S Milling

This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain.

Systematic Review: Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials

Visit

Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L

Objective: The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures.

Review: Clinical implications of unmanaged needle-insertion pain and distress in children

Visit

Kennedy RM, Luhmann J, Zempsky WT

This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.

Review: Needle pain in children: contextual factors

Visit

Walco GA

Pediatric pain experiences result from a complex interplay of genetic, experiential, and developmental factors. These elements, as they relate to needle-stick procedures and other relevant painful phenomena, are explored in this article so that the context of possible interventions may be more fully appreciated. Clinical implications are discussed incorporating ethical perspectives.

Review: Pharmacologic approaches for reducing venous access pain in children

Visit

Zempsky WT

A variety of pharmacologic options are available to clinicians who want to provide effective and safe topical local anesthesia to children undergoing venous access procedures. These options can be distinguished on the basis of how they deliver active drug through the impermeable outer layer of skin, the stratum corneum, to pain receptors located in the dermis and epidermis. Three general methodologies are typically used to bypass the stratum corneum: direct injection of local anesthetics, usually via a small-gauge hypodermic syringe; passive diffusion from topical creams or gels; and active needle-free drug strategies that enhance the rate of drug passage into the dermis and epidermis.

Cochrane Systematic Review: Venepuncture versus heel lance for blood sampling in term neonates

Visit

Shah V, Ohlsson A

Objectives: To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates.

Systematic Review: Theroleofparentalpresencein thecontextofchildren'smedicalprocedures: asystematic review.

Visit

Piira T,Sugiura T,Champion GD,Donnelly N,Cole AS

There are conflicting views and practices regarding whether or not parents should be present at the time of their child's medical procedure. A systematic review was conducted to assess the effects of parental presence in the paediatric treatment room on child, parent and health professional outcomes and to synthesize this body of literature.

Cochrane Systematic Review: To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates

Visit

Farion K, Osmond MH, Hartling L, Russell K, Klassen T, Crumley E, Wiebe N

Objectives: To summarize the best available evidence for the effect of tissue adhesives in the management of traumatic lacerations in children and adults.

Key studies English (25) French All (25)

Key Study: A Randomized Double Blind Trial of Needle-free Injected Lidocaine Versus Topical Anesthesia for Infant Lumbar Puncture.

Visit

Caltagirone R,Raghavan VR,Adelgais K,Roosevelt GE

Objectives:Lumbar punctures (LPs) are commonly performed in febrile infants to evaluate for meningitis, and local anesthesia increases the likelihood of LP success. Traditional methods of local anesthesia require injection that may be painful or topical application that is not effective immediately. Recent advances in needle-free jet injection may offer a rapid alternative to these modalities. We compared a needle-free jet-injection system (J-Tip) with 1% buffered lidocaine to topical anesthetic (TA) cream for local anesthesia in infant LPs.

Key Study: ComparisonofChildren'sVenipunctureFearandPain:Randomized Controlled TrialofEMLA andJ-TipNeedlelessInjectionSystem.

Visit

Stoltz P,Manworren RCB

Purpose:Needle procedures, like venipuncture and intravenous (IV) catheter insertion, are recognized as a common cause of pain and fear for children in hospitals and emergency departments. The purpose of this study was to compare children's self-reported pain and fear related to IV insertion with administration of either the topical local anesthetic EMLA or 1% buffered lidocaine delivered with the J-Tip Needleless Injection System (J-Tip)

Key Study: A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

Visit

Lunoe MM, Drendel AL, Levas MN, Weisman SJ, Dasgupta M, Hoffmann RG, Broussea...

Study Objective: The J-Tip (National Medical Products Inc, Irvine, CA) uses air instead of a needle to push lidocaine into the skin. To our knowledge, no studies have investigated its use for venipuncture in young children. We determine whether the J-Tip decreased venipuncture pain in young children compared with vapocoolant spray.

Ket Study: Accuracyof anewclean-catchtechniquefordiagnosisofurinarytractinfectionininfantsyoungerthan90daysofage

Visit

Herreros ML,Tagarro A,Garca-Pose A,Snchez A,Caete A,Gili P.

Objective:To evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique.

Key Study: Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial

Visit

Hartling L, Newton AS, Liang Y, Jou H, Hewson K, Klassen TP, Curtis S

Objective: To compare music with standard care to manage pain and distress.

Key Study: Needle-free jet injection of lidocaine for local anesthesia during lumbar puncture: a randomized controlled trial

Visit

Ferayorni A, Yniguez R, Bryson M, Bulloch B

Lumbar puncture (LP) is an essential procedure in the emergency department (ED) for the evaluation of meningitis. Subcutaneous injection of lidocaine before LP for local anesthesia is not a pain-free procedure. The J-Tip device allows an intradermal needle-free jet injection of 1% buffered lidocaine. This study compares needle-free jet injection of lidocaine to saline in reducing pain before LP in infants.

Key Study: A comparison of amethocaine and liposomal lidocaine cream as a pain reliever before venipuncture in children: a randomized control trial

Visit

Poonai N, Alawi K, Rieder M, Lynch T, Lim R

Objective: Although the use of anesthetic creams before intravenous (IV) insertion has been shown to be both safe and effective in decreasing pain during IV cannulation, the use of any single agent based on efficacy is not yet considered the standard of care in children. We sought to compare a commonly used preparation, 4% liposomal lidocaine (Maxilene), with 4% amethocaine (Ametop), a newer agent with reportedly good efficacy and an intrinsic vasodilatory effect.

Key Study: Equimolar nitrous oxide/oxygen versus placebo for procedural pain in children: a randomized trial

Visit

Reinoso-Barbero F, Pascual-Pascual SI, de Lucas R, Garca S, Billot C, Dequenn...

Objective: This randomized, single-dose, double-blind, Phase III study was designed to compare the level of procedural pain after use of premixed equimolar mixture of 50% oxygen and nitrous oxide (EMONO) or placebo (premixed 50% nitrogen and oxygen).

Key Study: Epidemiology and management of painful procedures in children in Canadian hospitals

Visit

Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, Barwick M, ...

We undertook this study to determine, for children in Canadian hospitals, the frequency of painful procedures, the types of pain management interventions associated with painful procedures and the influence of the type of hospital unit on procedural pain management.

Key Study: Impact of Parent-Provided Distraction on Child Responses to an IV Insertion

Visit

McCarthy AM, Kleiber C, Hanrahan K, Zimmerman MB, Westhus N, Allen S

This study evaluates the impact of parent-provided distraction on children's responses (behavioral, physiological, parent, and self-report) during an IV insertion.

Key Study: A randomized, double-blind controlled study of jet lidocaine compared to jet placebo for pain relief in children undergoing needle insertion in the emergency department

Visit

Auerbach M, Tunik M, Mojica M

Objectives: The objectives were to determine whether pretreatment with needleless jet-delivered lidocaine decreases self-reported pain in children undergoing needle insertion in the emergency department (ED) and to explore whether pretreatment with a jet device decreases self-reported pain in children undergoing needle insertion in the ED.

Key Study: Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children: a randomized controlled trial

Visit

Spanos S, Booth R, Koenig H, Sikes K, Gracely E, Kim IK

Objective: Comparison of the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine to the anesthetic effectiveness of topical 4% ELA-Max for PIV catheter insertion.

Key Study: A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department

Visit

Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T

Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population.

Key Study: Lumbar puncture success rate is not influenced by family-member presence

Visit

Nigrovic LE, McQueen AA, Neuman MI

Objective: Our goal was to evaluate the association between family-member presence and lumbar puncture success rates.

Key Study: Risk factors for traumatic or unsuccessful lumbar punctures in children

Visit

Nigrovic LE, Kuppermann N, Neuman MI

Study Objective: Traumatic and unsuccessful lumbar punctures can cause substantial diagnostic ambiguity that may lead to unnecessary antibiotic use and hospitalization, in addition to patient discomfort. Risk factors for obtaining traumatic and unsuccessful lumbar punctures have been studied in a limited fashion only. We sought to determine patient, physician, and procedural factors associated with traumatic and unsuccessful lumbar punctures in children.

Key Study: Local anesthetic and stylet styles: factors associated with resident lumbar puncture success

Visit

Baxter AL, Fisher RG, Burke BL, Goldblatt SS, Isaacman DJ, Lawson ML

Objective: To assess the effects of procedural techniques, local anesthetic use, and postgraduate training level on lumbar puncture (LP) success rates.

Key Study: A comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient

Visit

Jimenez N, Bradford H, Seidel KD, Sousa M, Lynn AM

Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement.

Key Study: A randomized comparison of nitrous oxide plus hematoma block versus ketamine plus midazolam for emergency department forearm fracture reduction in children

Visit

Luhmann JD, Schootman M, Luhmann SJ, Kennedy RM

Objectives: Ketamine provides effective and relatively safe sedation analgesia for reduction of fractures in children in the emergency department. However, prolonged recovery and adverse effects suggest the opportunity to develop alternative strategies. We compared the efficacy and adverse effects of ketamine/midazolam to those of nitrous oxide/hematoma block for analgesia and anxiolysis during forearm fracture reduction in children.

Key Study: A randomized, controlled trial of sucrose analgesia in infants younger than 90 days of age who require bladder catheterization in the pediatric emergency department

Visit

Rogers AJ, Greenwald MH, Deguzman MA, Kelley ME, Simon HK

Objectives: To determine whether an oral sucrose solution improves pain response for infants undergoing bladder catheterization in an emergency department (ED) population.

Key Study: Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial

Visit

Taddio A, Soin HK, Schuh S, Koren G, Scolnik D

Historically, children have been undertreated for their pain, and they continue to undergo painful cutaneous procedures without analgesics. A new topical anesthetic, liposomal lidocaine 4% cream (Maxilene, RGR Pharma, Windsor, Ont.), has become available. It has pharmacologic properties that are superior to other topical anesthetics, including an onset of action of only 30 minutes. We sought to determine the success rate of cannulation, analgesic effectiveness, procedure duration and rate of adverse skin reactions when liposomal lidocaine is used before intravenous cannulation of children.

Key Study: The anesthetic effectiveness of lidocaine-adrenaline-tetracaine gel on finger lacerations

Visit

White NJ, Kim MK, Brousseau DC, Bergholte J, Hennes H

Objectives: To determine the effectiveness of lidocaine-adrenaline-tetracaine (LAT) in providing adequate anesthesia for the repair of finger lacerations and to monitor the risk of digital ischemia following application of LAT gel to finger lacerations.

Key Study: A comparison of buffered lidocaine versus ELA-Max before peripheral intravenous catheter insertions in children

Visit

Luhmann J, Hurt S, Shootman M, Kennedy R

Objective: To compare the reduction of pain and anxiety during peripheral intravenous catheter insertion provided by subcutaneous buffered 1% lidocaine or topical ELA-Max in children.

Key Study: Effects of chewing gum on responses to routine painful procedures in children

Visit

Lewkowski MD, Barr RG, Sherrard A, Lessard J, Harris AR, Young SN

In infants, sweet taste and sucking on a pacifier both have analgesic effects. Animal studies suggest that sweet taste may involve opioids, while rhythmic oral movements, as with a pacifier, increase the release of serotonin, which is involved in the gating of nociceptive afferents. The present study was designed to see if these effects produce an analgesic effect in children. Two studies were performed, during blood draws in a pediatric test center in 7- to 12-year-old children, and during vaccination at school in 9- to 11-year-old children.

Key Study: Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial

Visit

Priestley S, Kelly AM, Chow L, Powell C, Williams A

Study Objectives: We determine whether application of topical local anesthetic at triage reduces total treatment time for children with simple lacerations.

Key Study: Buffered lidocaine: analgesia for intravenous line placement in children

Visit

Klein EJ, Shugerman RP, Leigh-Taylor K, Schneider C, Portscheller D, Koepsell T

Objectives: To evaluate the effectiveness of intradermal buffered lidocaine as analgesia before intravenous line (i.v.) placement in children.

Key Study: A Randomized Double Blind Trial of Needle-free Injected Lidocaine Versus Topical Anesthesia for Infant Lumbar Puncture.

Visit

Caltagirone R,Raghavan VR,Adelgais K,Roosevelt GE

Objectives:Lumbar punctures (LPs) are commonly performed in febrile infants to evaluate for meningitis, and local anesthesia increases the likelihood of LP success. Traditional methods of local anesthesia require injection that may be painful or topical application that is not effective immediately. Recent advances in needle-free jet injection may offer a rapid alternative to these modalities. We compared a needle-free jet-injection system (J-Tip) with 1% buffered lidocaine to topical anesthetic (TA) cream for local anesthesia in infant LPs.

Key Study: ComparisonofChildren'sVenipunctureFearandPain:Randomized Controlled TrialofEMLA andJ-TipNeedlelessInjectionSystem.

Visit

Stoltz P,Manworren RCB

Purpose:Needle procedures, like venipuncture and intravenous (IV) catheter insertion, are recognized as a common cause of pain and fear for children in hospitals and emergency departments. The purpose of this study was to compare children's self-reported pain and fear related to IV insertion with administration of either the topical local anesthetic EMLA or 1% buffered lidocaine delivered with the J-Tip Needleless Injection System (J-Tip)

Key Study: A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

Visit

Lunoe MM, Drendel AL, Levas MN, Weisman SJ, Dasgupta M, Hoffmann RG, Broussea...

Study Objective: The J-Tip (National Medical Products Inc, Irvine, CA) uses air instead of a needle to push lidocaine into the skin. To our knowledge, no studies have investigated its use for venipuncture in young children. We determine whether the J-Tip decreased venipuncture pain in young children compared with vapocoolant spray.

Ket Study: Accuracyof anewclean-catchtechniquefordiagnosisofurinarytractinfectionininfantsyoungerthan90daysofage

Visit

Herreros ML,Tagarro A,Garca-Pose A,Snchez A,Caete A,Gili P.

Objective:To evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique.

Key Study: Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial

Visit

Hartling L, Newton AS, Liang Y, Jou H, Hewson K, Klassen TP, Curtis S

Objective: To compare music with standard care to manage pain and distress.

Key Study: Needle-free jet injection of lidocaine for local anesthesia during lumbar puncture: a randomized controlled trial

Visit

Ferayorni A, Yniguez R, Bryson M, Bulloch B

Lumbar puncture (LP) is an essential procedure in the emergency department (ED) for the evaluation of meningitis. Subcutaneous injection of lidocaine before LP for local anesthesia is not a pain-free procedure. The J-Tip device allows an intradermal needle-free jet injection of 1% buffered lidocaine. This study compares needle-free jet injection of lidocaine to saline in reducing pain before LP in infants.

Key Study: A comparison of amethocaine and liposomal lidocaine cream as a pain reliever before venipuncture in children: a randomized control trial

Visit

Poonai N, Alawi K, Rieder M, Lynch T, Lim R

Objective: Although the use of anesthetic creams before intravenous (IV) insertion has been shown to be both safe and effective in decreasing pain during IV cannulation, the use of any single agent based on efficacy is not yet considered the standard of care in children. We sought to compare a commonly used preparation, 4% liposomal lidocaine (Maxilene), with 4% amethocaine (Ametop), a newer agent with reportedly good efficacy and an intrinsic vasodilatory effect.

Key Study: Equimolar nitrous oxide/oxygen versus placebo for procedural pain in children: a randomized trial

Visit

Reinoso-Barbero F, Pascual-Pascual SI, de Lucas R, Garca S, Billot C, Dequenn...

Objective: This randomized, single-dose, double-blind, Phase III study was designed to compare the level of procedural pain after use of premixed equimolar mixture of 50% oxygen and nitrous oxide (EMONO) or placebo (premixed 50% nitrogen and oxygen).

Key Study: Epidemiology and management of painful procedures in children in Canadian hospitals

Visit

Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, Barwick M, ...

We undertook this study to determine, for children in Canadian hospitals, the frequency of painful procedures, the types of pain management interventions associated with painful procedures and the influence of the type of hospital unit on procedural pain management.

Key Study: Impact of Parent-Provided Distraction on Child Responses to an IV Insertion

Visit

McCarthy AM, Kleiber C, Hanrahan K, Zimmerman MB, Westhus N, Allen S

This study evaluates the impact of parent-provided distraction on children's responses (behavioral, physiological, parent, and self-report) during an IV insertion.

Key Study: A randomized, double-blind controlled study of jet lidocaine compared to jet placebo for pain relief in children undergoing needle insertion in the emergency department

Visit

Auerbach M, Tunik M, Mojica M

Objectives: The objectives were to determine whether pretreatment with needleless jet-delivered lidocaine decreases self-reported pain in children undergoing needle insertion in the emergency department (ED) and to explore whether pretreatment with a jet device decreases self-reported pain in children undergoing needle insertion in the ED.

Key Study: Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children: a randomized controlled trial

Visit

Spanos S, Booth R, Koenig H, Sikes K, Gracely E, Kim IK

Objective: Comparison of the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine to the anesthetic effectiveness of topical 4% ELA-Max for PIV catheter insertion.

Key Study: A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department

Visit

Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T

Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population.

Key Study: Lumbar puncture success rate is not influenced by family-member presence

Visit

Nigrovic LE, McQueen AA, Neuman MI

Objective: Our goal was to evaluate the association between family-member presence and lumbar puncture success rates.

Key Study: Risk factors for traumatic or unsuccessful lumbar punctures in children

Visit

Nigrovic LE, Kuppermann N, Neuman MI

Study Objective: Traumatic and unsuccessful lumbar punctures can cause substantial diagnostic ambiguity that may lead to unnecessary antibiotic use and hospitalization, in addition to patient discomfort. Risk factors for obtaining traumatic and unsuccessful lumbar punctures have been studied in a limited fashion only. We sought to determine patient, physician, and procedural factors associated with traumatic and unsuccessful lumbar punctures in children.

Key Study: Local anesthetic and stylet styles: factors associated with resident lumbar puncture success

Visit

Baxter AL, Fisher RG, Burke BL, Goldblatt SS, Isaacman DJ, Lawson ML

Objective: To assess the effects of procedural techniques, local anesthetic use, and postgraduate training level on lumbar puncture (LP) success rates.

Key Study: A comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient

Visit

Jimenez N, Bradford H, Seidel KD, Sousa M, Lynn AM

Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement.

Key Study: A randomized comparison of nitrous oxide plus hematoma block versus ketamine plus midazolam for emergency department forearm fracture reduction in children

Visit

Luhmann JD, Schootman M, Luhmann SJ, Kennedy RM

Objectives: Ketamine provides effective and relatively safe sedation analgesia for reduction of fractures in children in the emergency department. However, prolonged recovery and adverse effects suggest the opportunity to develop alternative strategies. We compared the efficacy and adverse effects of ketamine/midazolam to those of nitrous oxide/hematoma block for analgesia and anxiolysis during forearm fracture reduction in children.

Key Study: A randomized, controlled trial of sucrose analgesia in infants younger than 90 days of age who require bladder catheterization in the pediatric emergency department

Visit

Rogers AJ, Greenwald MH, Deguzman MA, Kelley ME, Simon HK

Objectives: To determine whether an oral sucrose solution improves pain response for infants undergoing bladder catheterization in an emergency department (ED) population.

Key Study: Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial

Visit

Taddio A, Soin HK, Schuh S, Koren G, Scolnik D

Historically, children have been undertreated for their pain, and they continue to undergo painful cutaneous procedures without analgesics. A new topical anesthetic, liposomal lidocaine 4% cream (Maxilene, RGR Pharma, Windsor, Ont.), has become available. It has pharmacologic properties that are superior to other topical anesthetics, including an onset of action of only 30 minutes. We sought to determine the success rate of cannulation, analgesic effectiveness, procedure duration and rate of adverse skin reactions when liposomal lidocaine is used before intravenous cannulation of children.

Key Study: The anesthetic effectiveness of lidocaine-adrenaline-tetracaine gel on finger lacerations

Visit

White NJ, Kim MK, Brousseau DC, Bergholte J, Hennes H

Objectives: To determine the effectiveness of lidocaine-adrenaline-tetracaine (LAT) in providing adequate anesthesia for the repair of finger lacerations and to monitor the risk of digital ischemia following application of LAT gel to finger lacerations.

Key Study: A comparison of buffered lidocaine versus ELA-Max before peripheral intravenous catheter insertions in children

Visit

Luhmann J, Hurt S, Shootman M, Kennedy R

Objective: To compare the reduction of pain and anxiety during peripheral intravenous catheter insertion provided by subcutaneous buffered 1% lidocaine or topical ELA-Max in children.

Key Study: Effects of chewing gum on responses to routine painful procedures in children

Visit

Lewkowski MD, Barr RG, Sherrard A, Lessard J, Harris AR, Young SN

In infants, sweet taste and sucking on a pacifier both have analgesic effects. Animal studies suggest that sweet taste may involve opioids, while rhythmic oral movements, as with a pacifier, increase the release of serotonin, which is involved in the gating of nociceptive afferents. The present study was designed to see if these effects produce an analgesic effect in children. Two studies were performed, during blood draws in a pediatric test center in 7- to 12-year-old children, and during vaccination at school in 9- to 11-year-old children.

Key Study: Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial

Visit

Priestley S, Kelly AM, Chow L, Powell C, Williams A

Study Objectives: We determine whether application of topical local anesthetic at triage reduces total treatment time for children with simple lacerations.

Key Study: Buffered lidocaine: analgesia for intravenous line placement in children

Visit

Klein EJ, Shugerman RP, Leigh-Taylor K, Schneider C, Portscheller D, Koepsell T

Objectives: To evaluate the effectiveness of intradermal buffered lidocaine as analgesia before intravenous line (i.v.) placement in children.

undefined English (5) French All (5)

Emergency Medicine Cases Podcast: Pediatric Procedural Sedation (2016)

Visit

Dr. Amy Drendel

Episode 76: Join Dr. Amy Drendel, a world leader in pediatric pain management and procedural sedation research, as she discusses how best to manage pain and anxiety in three situations in the ED: the child with a painful fracture, the child who requires imaging in the radiology department and the child who requires a lumbar puncture.

Published online: February 2016

How to Help When Your Child Needs to Get a Needle Poke

Visit

ECHO, ARCHE & TREKK

Needle pokes are one of the most common sources of pain for children seeking emergency medical care. Needle pokes may be used during healthcare visits to collect blood, deliver medication and fluids, or to numb certain body parts while stitching, for example. This interactive infographic provides useful age-specific tips for parents and families who have a child that may require a needle poke.

This infographic was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Website: Pain Assessment and Management Initiative (PAMI)

Visit

Pain Assessment and Management Initiative (PAMI) is an e-Learning and patient safety educational project funded through a grant by the Florida Medical Malpractice Joint Underwriting Association. The overall goal of PAMI is to improve the safety of patients of all ages by developing tools and learning modules for health care providers to recognize, assess, and manage acute and chronic pain in acute care settings such as the Emergency Department. The tools and resources developed are designed to be used, adapted and implemented by any health care facility or agency based on their specific needs. The PAMI site also includes pain related resourcesapps/podcasts and learning modules. PAMI learning modules and materials are developed by a state and national expert panel and are multidisciplinary, targeting physicians, nurses, PAs, pharmacists, paramedics, hospital patient safety officers, risk managers and other providers.

Resource - Acute Procedural Pain Toolkits

Visit

Canadian Association of Paediatric Health Centres Pain Community of Practice

These Toolkits are a resource for clinicians who work with children that may experience acute procedural pain and support moving best practice recommendations into practice. Based on the best research evidence and clinical practice, these Toolkits bring together a collection of evidence-based recommendations, clinical and family resources, policy examples, pre-populated power point templates, videos, and background articles with the purpose of making these recommendations easier to move into practice. 

There are eight toolkits to choose from: 

  • Assessment
  • Distraction
  • Intranasal fentanyl
  • Breast feeding, non-nutritive sucking, and positioning
  • Oral sucrose
  • Pain with suturing
  • Topical anesthetics (venipuncture)
  • Implementation strategies

VIDEO: How to help when your child needs a needle poke

Visit

Needle pokes are one of the most common sources of pain for children seeking emergency medical care. Needle pokes may be used during healthcare visits to collect blood, deliver medication and fluids, or to numb certain body parts while stitching, for example. This video provides information about needle pokes and useful tips for parents and families who have a child that may require a needle poke. 

This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

 

Emergency Medicine Cases Podcast: Pediatric Procedural Sedation (2016)

Visit

Dr. Amy Drendel

Episode 76: Join Dr. Amy Drendel, a world leader in pediatric pain management and procedural sedation research, as she discusses how best to manage pain and anxiety in three situations in the ED: the child with a painful fracture, the child who requires imaging in the radiology department and the child who requires a lumbar puncture.

Published online: February 2016

How to Help When Your Child Needs to Get a Needle Poke

Visit

ECHO, ARCHE & TREKK

Needle pokes are one of the most common sources of pain for children seeking emergency medical care. Needle pokes may be used during healthcare visits to collect blood, deliver medication and fluids, or to numb certain body parts while stitching, for example. This interactive infographic provides useful age-specific tips for parents and families who have a child that may require a needle poke.

This infographic was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Website: Pain Assessment and Management Initiative (PAMI)

Visit

Pain Assessment and Management Initiative (PAMI) is an e-Learning and patient safety educational project funded through a grant by the Florida Medical Malpractice Joint Underwriting Association. The overall goal of PAMI is to improve the safety of patients of all ages by developing tools and learning modules for health care providers to recognize, assess, and manage acute and chronic pain in acute care settings such as the Emergency Department. The tools and resources developed are designed to be used, adapted and implemented by any health care facility or agency based on their specific needs. The PAMI site also includes pain related resourcesapps/podcasts and learning modules. PAMI learning modules and materials are developed by a state and national expert panel and are multidisciplinary, targeting physicians, nurses, PAs, pharmacists, paramedics, hospital patient safety officers, risk managers and other providers.

Resource - Acute Procedural Pain Toolkits

Visit

Canadian Association of Paediatric Health Centres Pain Community of Practice

These Toolkits are a resource for clinicians who work with children that may experience acute procedural pain and support moving best practice recommendations into practice. Based on the best research evidence and clinical practice, these Toolkits bring together a collection of evidence-based recommendations, clinical and family resources, policy examples, pre-populated power point templates, videos, and background articles with the purpose of making these recommendations easier to move into practice. 

There are eight toolkits to choose from: 

  • Assessment
  • Distraction
  • Intranasal fentanyl
  • Breast feeding, non-nutritive sucking, and positioning
  • Oral sucrose
  • Pain with suturing
  • Topical anesthetics (venipuncture)
  • Implementation strategies

VIDEO: How to help when your child needs a needle poke

Visit

Needle pokes are one of the most common sources of pain for children seeking emergency medical care. Needle pokes may be used during healthcare visits to collect blood, deliver medication and fluids, or to numb certain body parts while stitching, for example. This video provides information about needle pokes and useful tips for parents and families who have a child that may require a needle poke. 

This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

 

Resources For Patients and Families...