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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.

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Key Resources English (6) French (1) All (7)

Bottom Line Recommendations: Procedural Pain

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Ali, S, Drendel A & TREKK Network

Bottom line recommendations for the treatment and management of procedural pain. Published online: November 2016, update May 2021

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

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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 newbo

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.

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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 t

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

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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/

Bottom Line: Psychological Interventions

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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

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

Recommandations de Base: Douleur procdurale

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French Bottom line recommendations for the treatment and management of procedural pain. Published online: March 2017, v.2.0 May 2021

Recommandations de Base: Douleur procdurale

Download

French Bottom line recommendations for the treatment and management of procedural pain. Published online: March 2017, v.2.0 May 2021

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, update May 2021

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 newbo

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 t

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/

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

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

Clinical guidelines English (11) French All (11)

Managing acute pain in children presenting to the emergency department without opioids

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Corrie E Chumpitazi1,Cindy Chang2,Zaza Atanelov3,Ann M Dietrich4,Samuel Hiu-F...

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

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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: Needle-Related or Minor Procedural Pain in Pediatric Patients

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ENA Clinical Practice Guideline Committee; ENA Board of Directors Liaisons:; ...

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

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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

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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

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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

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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 succinylchol

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 appropr

Managing acute pain in children presenting to the emergency department without opioids

Visit

Corrie E Chumpitazi1,Cindy Chang2,Zaza Atanelov3,Ann M Dietrich4,Samuel Hiu-F...

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: Needle-Related or Minor Procedural Pain in Pediatric Patients

Visit

ENA Clinical Practice Guideline Committee; ENA Board of Directors Liaisons:; ...

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 succinylchol

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 appropr

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 laceration

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 t

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 swe

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') a

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 nee

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 orvenepun

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 thatvenepunc

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

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 laceration

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 t

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 swe

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') a

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 nee

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 orvenepun

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 thatvenepunc

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

Systematic reviews English (30) French All (30)

Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review

Visit

Pansini V, Curatola A, Gatto A, Lazzareschi I, Ruggiero A, Chiaretti A.

Acute pain is one of the most common symptoms in children admitted to the Pediatric Emergency Department (PED) and its management represents a real clinical challenge for pediatricians.

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.

Local and Topical Anesthetics for Pediatric Patients in theEmergencyDepartment

Visit

Mace SE, Whiteman P, Avarello JT, Ojo A, Rose E, Valente J, Joseph M

Painful diagnostic and therapeutic procedures are common in the emergency department. Adequately treating pain, including the pain of procedures is an essential component of the practice of emergency medicine.

Efficacy of the Buzzy Device for Pain Management During Needle-related Procedures: A Systematic Review and Meta-Analysis

Visit

Ballard A, Khadra C, Adler S, Trottier ED, Le May S.

Objective:This systematic review and meta-analysis examined the effectiveness of the Buzzy device combining cold and vibration for needle-related procedural pain in children.

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 sy

The role of inhaled methoxyflurane in acute pain management

Visit

Porter KM, Dayan AD, Dickerson S, Middleton PM.

Methoxyflurane is an inhaled analgesic administered via a disposable inhaler which has been used in Australia for over 40 years for the management of pain associated with trauma and for medical procedures in children and adults. Now available in 16 countr

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

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 i

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,

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 reac

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 futu

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-pharmacolo

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, g

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 reac

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

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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 contex

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

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 c

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.

Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review

Visit

Pansini V, Curatola A, Gatto A, Lazzareschi I, Ruggiero A, Chiaretti A.

Acute pain is one of the most common symptoms in children admitted to the Pediatric Emergency Department (PED) and its management represents a real clinical challenge for pediatricians.

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.

Local and Topical Anesthetics for Pediatric Patients in theEmergencyDepartment

Visit

Mace SE, Whiteman P, Avarello JT, Ojo A, Rose E, Valente J, Joseph M

Painful diagnostic and therapeutic procedures are common in the emergency department. Adequately treating pain, including the pain of procedures is an essential component of the practice of emergency medicine.

Efficacy of the Buzzy Device for Pain Management During Needle-related Procedures: A Systematic Review and Meta-Analysis

Visit

Ballard A, Khadra C, Adler S, Trottier ED, Le May S.

Objective:This systematic review and meta-analysis examined the effectiveness of the Buzzy device combining cold and vibration for needle-related procedural pain in children.

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

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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 sy

The role of inhaled methoxyflurane in acute pain management

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Porter KM, Dayan AD, Dickerson S, Middleton PM.

Methoxyflurane is an inhaled analgesic administered via a disposable inhaler which has been used in Australia for over 40 years for the management of pain associated with trauma and for medical procedures in children and adults. Now available in 16 countr

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

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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

Systematic Review: LidocaineGelforUrethralCatheterizationinChildren: AMeta-Analysis.

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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.

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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 i

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

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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

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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

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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,

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

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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 reac

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

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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

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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

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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 futu

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

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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-pharmacolo

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

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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, g

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

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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

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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 reac

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

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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

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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

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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

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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 contex

Review: Pharmacologic approaches for reducing venous access pain in children

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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

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

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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.

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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 c

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

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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 (6) French All (6)

Emergency department strategies to combat the opioid crisis in children and adolescents

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Cindy D Chang1,Mohsen Saidinejad1,Zaza Atanelov2,Ann M Dietrich3,Samuel Hiu-F...

The opioid crisis has greatly affected not only adults but also children as well. As clinicians develop effective approaches to minimize pain and distress in children, the risks and benefits of opioids must be carefully considered. Children of parents wit

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

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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 a

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

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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

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

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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

Ket Study: Accuracyof anewclean-catchtechniquefordiagnosisofurinarytractinfectionininfantsyoungerthan90daysofage

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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

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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.

Emergency department strategies to combat the opioid crisis in children and adolescents

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Cindy D Chang1,Mohsen Saidinejad1,Zaza Atanelov2,Ann M Dietrich3,Samuel Hiu-F...

The opioid crisis has greatly affected not only adults but also children as well. As clinicians develop effective approaches to minimize pain and distress in children, the risks and benefits of opioids must be carefully considered. Children of parents wit

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 a

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

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

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

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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.

Other English (6) French All (6)

Emergency Medicine Cases Podcast: Pediatric Procedural Sedation (2016)

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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

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

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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.

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

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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 e

Website: Pain Assessment and Management Initiative (PAMI)

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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

Resource - Acute Procedural Pain Toolkits

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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

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

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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 whil

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

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.

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 e

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

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

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 whil

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