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Patients and Family Resources

all patients and families resources









Resources in Evidence Repository and Individual Compendia

Bottom Line Recommendations

UNDER REVIEW 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.

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 newborns in the first month of life is not reviewed here. Four reviews relevant to the management of childrens pain are currently available

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

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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.

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 the ED and beyond.

UNDER REVIEW: 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.

Bottom Line Recommendations: Procedural Sedation

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Evered L, Bhatt M & TREKK Network

Bottom line recommendations for pediatric procedural sedation. Published online: March 2018.

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/abrasions).

Measurement Tool: Faces Pain Scale - Revised for children 4 years of age and older

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International Association for the Study of Pain

Scores are from the left to the right (for the child): 0, 2, 4, 6, 8, 10 (0 for no pain at all and 10 for very, very much in pain).

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 in managing any future procedures. Reducing both pain and anxiety will facilitate effective coping.

Chart: WHO pain wall chart for waiting rooms

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World Health Organization

Is your child in pain? The doctor can help. As for pain treatment!

Bottom Line Recommendations: Pain Treatment

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Ali, S, Drendel A and TREKK Network

Bottom line recommendations for pediatric pain treatment. Published online: May 2018.

Bottom Line Recommenation: Optimal pain relief for pediatric MSK injury.

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Korownyk C, Young J, Michael Allan G

Evidence suggests that ibuprofen provides better single-agent relief than acetaminophen or codeine, and is at least equivalent to both acetaminophen with codeine and morphine for acute injury pain, with fewer adverse events.

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.

Clinical guidelines

Video: Procedural sedation and analgesia in children

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Krauss BS, Krauss BA, Green SM.

This video describe procedural sedation and analgesia for children. Published: April 2014.

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: 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

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.

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.

Clinical Practice Guideline: AboutKidsHealth: Tools for measuring pain

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Stinson, J

Objectives: To assess the level of pain felt by children through the use of pain scales and other measurement tools such as behavioural and composite measures.

Clinical Guideline: Clinical policy: procedural sedation and analgesia in the emergency department

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Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, Fesmire FM,...

This clinical policy from the American College of Emergency Physicians is the revision of a 2005 clinical policy evaluating critical questions related to procedural sedation in the emergency department.

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

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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

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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

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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: 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 childs and familys 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.

Clincial Practice Guideline: Optimizing the treatment of pain in patients with acute presentations

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American Society for Pain Management Nursing (ASPMN), Emergency Nurses Associ...

Management of pain is an essential nursing and physician responsibility. This joint position statement describes recommendations for improving pain management in health care settings.

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

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Royal College of Nursing

The Royal College of Nursing (RCN) has previously produced a guideline on the Assessment of acute pain in children (2000). This guideline examined when pain in children should be assessed and by whom, and the use of scales and other tools that can be used to facilitate the assessment of childrens pain.

Clinical Practice Guideline: The assessment and management of acute pain in infants, children, and adolescents

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American Academy of Pediatrics

Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly, use a multimodal approach to pain management, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.

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: Management of acute pediatric pain in the emergency department.

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Ruest S,Anderson A.

This article provides a summary of recommendations for the multimodal and multidisciplinary approach to acute pediatric pain management and highlights recent research on this topic.

Clinical Practice Guideline: Effective Management of Pain and Anxiety for the Pediatric Patient in the Emergency Department.

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Young VB

A summary of what to expect with pediatric patients experiencing pain and anxiety.

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

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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.

Summaries of systematic reviews

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

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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: Breastfeeding or breast milk for procedural pain in neonates

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

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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: Nonpharmacological management of infant and young child procedural pain

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

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

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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 Summary: Intranasal fentanyl for the treatment of children in acute pain

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Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Background: Pain is the most common reason why patients are seen in emergency departments (EDs). The challenging nature of treating children in acute severe pain is reflected in the medical literature by poor pain management in this population. We reviewed evidence on the effect of intranasal fentanyl (INF) (a strong pain relief drug, similar to morphine) compared with any other pain-relieving technique for treatment of children in acute severe pain. Study characteristics: We included studies with children (younger than 18 years of age) suffering from acute severe pain as a result of injury or medical illness. The target intervention was INF administered for pain relief compared with any other drug intervention for pain relief (e.g. intravenous morphine) or non-drug intervention (e.g. limb splinting, wound dressing) provided in the emergency setting. The evidence is current to January 2014. Key results: We identified three studies that included 313 children with acute severe pain resulting from broken bones of the upper and lower limbs. These trials compared INF versus morphine administered by a needle into a muscle (intramuscular morphine) or via a drip into a vein (intravenous morphine), as well as standard concentration INF versus high concentration INF. The collective study population in these trials consisted of children three to 15 years of age. Males accounted for approximately two-thirds of the overall study population. The review concluded that INF may be an effective analgesic for the treatment of children in acute moderate to severe pain, and its administration appears to cause minimal distress to children; however, the evidence is insufficient to permit judgement of the effects of INF compared with intramuscular or intravenous morphine. No serious adverse events (e.g. opiate toxicity, death) were reported. Limitations: Limitations of this review include the following: Few studies (three) were eligible for inclusion; no study examined the use of INF in children younger than three years of age; no study included children with pain resulting from a "medical" cause (e.g. abdominal pain seen in appendicitis); and all eligible studies were conducted in Australia. Consequently, the findings may not be generalizable to other healthcare settings, to children younger than three years of age and to those with pain from a "medical" cause.

Cochrane Summary: Nerve blocks for initial pain management of thigh bone fractures in children

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Black KJ, Bevan CA, Murphy NG, Howard JJ

Fractures (breaks) of the thigh bone can be very painful, particularly when a child arrives in a stressful emergency environment and is undergoing assessment. Moving the child to get X-rays or transferring the child to a special bed to support the leg in traction (keeping the leg straight) can cause additional pain, as can placing traction (a pulling force) on the broken thigh. This means that prompt provision of pain relief is an essential part of initial emergency management. This review investigated whether a nerve block, involving the injection of a freezing/numbing medication at the top of the thigh, would provide more effective pain relief than pain medicine given by mouth or into a vein (intravenously, e.g. morphine). We searched several medical databases and trial registries up to January 2013 and contacted researchers. We found one study that looked at the comparison we were interested in. This study was potentially biased, mainly because the care providers, parents and children were aware of the type of pain relief the children received. The study was small, involving 55 children aged 16 months to 15 years, and showed that the children who received one of the two main types of nerve block tended to have less pain after 30 minutes than those who received intravenous morphine for initial pain control. The nerve blocks led to some pain and redness at the injection site in a few cases, while intravenous morphine caused more serious problems such as depressed breathing (lack of oxygen), excessive sleepiness and vomiting in a small number of children. Moreover, children who had nerve blocks continued to have lower pain scores over a six-hour period with less need for additional pain relief. There was insufficient evidence to determine whether children or parents were more satisfied with one method of pain relief than the other. Use of resources (e.g. nursing time, cost of medications) was not measured. The quality of the study included in this review was low and so these conclusions are not certain. Further well designed studies investigating whether nerve blocks are more effective and safer than other means of pain relief are needed.

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

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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: Sweet taste to ease injection needle 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

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: Pain relievers for children with acute middle ear infection

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Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

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

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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: Venepuncture versus heel lance for blood sampling in term neonates

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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

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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.

Overviews of systematic reviews

Overview of Systematic Reviews: What works and what's safe in pediatric emergency procedural sedation: an overview of reviews

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Hartling L, Milne A, Foisy M, Lang E, Sinclair D, Klassen TP, Evered L

This overview of systematic reviews examines the safety and efficacy of sedative agents commonly used for procedural sedation (propofol, ketamine, nitrous oxide, midazolam) in children in the ED or similar settings.

Systematic reviews

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, A...

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).

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-pharmacological pain-relieving methods.

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.

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-pharmacological pain-relieving methods.

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, 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

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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 reactivity, pain-related regulation).

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

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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: 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 systematic review and meta analysis to appraise the quality of published literature and to synthesize data for acute pain scores.

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: 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, 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

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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 reactivity, pain-related regulation).

Systematic Review: Intravenous vs intramuscular ketamine for pediatric procedural sedation by emergency medicine specialists: a review

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Deasy C, Babl FE

This review investigated existing evidence to determine whether ketamine should be best administered intravenously or intramuscularly.

Systematic Review: Professional skills and competence for safe and effective procedural sedation in children: recommendations based on a systematic review of the literature

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Leroy PL, Schipper DM, Knape HJ

This review investigated which skills and competence were imperative to assure optimal effectiveness and safety of procedural sedation (PS) in children and analyzed the underlying levels of evidence.

Systematic Review: Intranasal ketamine for procedural sedation and analgesia in children

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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Rieder M,...

Evidence suggests ketamine can be administered intranasally. This study reviews the evidence for intranasal ketamine for procedural sedation and analgesia in children.

Review: Update on pharmacological management of procedural sedation in children

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Roback MG, Carlson DW, Babl FE, Kennedy RM

This review provides an update on pharmacological techniques for procedural sedation for children outside the operating room.

Systematic Review: Hematoma block or procedural sedation and analgesia, which is the most effective method of anesthesia in reduction of displaced distal radius fracture?

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Tseng, PT, Leu, TH, Chen, YW and Chen, YP

The aim of this study was to compare HB and PSA for adult and pediatric patients during reduction of displaced distal radius fracture to identify the level of pain relief, frequency of adverse effects (AEs), and reduction failure.

Cochrane Systematic Review: Adjusting the pH of lidocaine for reducing pain on injection

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Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R

OBJECTIVES: The objective of this review was to determine if adjusting the pH of lidocaine had any effect on pain resulting from non-intravascular injections in adults and children. We tested the hypothesis that adjusting the pH of lidocaine solution to a level closer to the physiologic pH reduces this pain.

Cochrane Systematic Review: Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

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Andreae MH, Andreae DA

OBJECTIVES: To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery.

Cochrane Systematic Review: Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain

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Almeida MO, Silva BN, Andriolo RB, Atallah AN, Peccin MS

OBJECTIVES: To assess the effects (benefits and harms) of conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain.

Cochrane Systematic Review: Pharmacotherapy for patellofemoral pain syndrome

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Heintjes E, Berger MY, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW

OBJECTIVES: This review aims to summarise the evidence of effectiveness of pharmacotherapy in reducing anterior knee pain and improving knee function in people with PFPS.

Cochrane Systematic Review: Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

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Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C, Martin AE

OBJECTIVES: To determine the effectiveness of medication for recurrent abdominal pain in school-age children.

Cochrane Systematic Review: Antidepressants for the treatment of abdominal pain-related functional gastrointestinal disorders in children and adolescents

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Kaminski A, Kamper A, Thaler K, Chapman A, Gartlehner G

OBJECTIVES: The primary objectives were to conduct a systematic review to evaluate the efficacy and safety of antidepressants for the treatment of abdominal pain-related FGIDs in children and adolescents.

Cochrane Systematic Review: Oxcarbazepine for neuropathic pain

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Zhou M, Chen N, He L, Yang M, Zhu C, Wu F

OBJECTIVES: To determine the benefits and harms of oxcarbazepine for different forms of neuropathic pain.

Cochrane Systematic Review: EMLA and Amethocaine for reduction of children's pain associated with needle insertion

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Lander JA, Weltman BJ, So SS

OBJECTIVES: To compare the topical anaesthetics amethocaine and an eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy, ease of needle insertion and adverse events when used for intravenous cannulation and venipuncture in children.

Cochrane Systematic Review: Hydromorphone for acute and chronic pain

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Quigley C

OBJECTIVES: This review explores and assesses the evidence for the efficacy of hydromorphone in the management of pain.

Cochrane Systematic Review: Local anaesthetic sympathetic blockade for complex regional pain syndrome

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Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE

OBJECTIVES: To assess the efficacy of LASB for the treatment of pain in CRPS and to evaluate the incidence of adverse effects of the procedure.

Cochrane Systematic Review: NSAIDS or paracetamol, alone or combined with opioids, for cancer pain

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McNicol E, Strassels SA, Goudas L, Lau J, Carr DB

OBJECTIVES: To assess the effects of NSAIDs, alone or combined with opioids, for the treatment of cancer pain.

Cochrane Systematic Review: Oral morphine for cancer pain

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Wiffen PJ, Wee B, Moore RA

OBJECTIVES: To determine the efficacy of oral morphine in relieving cancer pain, and assess the incidence and severity of adverse effects.

Cochrane Systematic Review: Pharmacologic interventions for treating phantom limb pain

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Alviar MJ, Hale T, Dungca M

OBJECTIVES: This review aims to summarize the evidence of effectiveness of pharmacologic interventions in treating PLP.

Cochrane Systematic Review: Diclofenac for acute pain in children

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Standing JF, Savage I, Pritchard D, Waddington M

OBJECTIVES: 1) Assess the efficacy of diclofenac for acute pain in children. 2) Assess the safety of diclofenac for short-term use in children. 3) Identify gaps in the evidence to direct future research.

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.

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 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.

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 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

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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 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: Intranasal fentanyl for the management of acute pain in children

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Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Objective: We identified and evaluated all randomized controlled trials (RCTs) and quasi-randomized trials to assess the effects of intranasal fentanyl (INF) versus alternative analgesic interventions in children with acute pain, with respect to reduction in pain score, occurrence of adverse events, patient tolerability, use of "rescue analgesia," patient/parental satisfaction and patient mortality.

Systematic Review: Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis

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Poonai N, Paskar D, Konrad SL, Rieder M, Joubert G, Lim R, Golozar A, Uledi S...

Objectives: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications.

Cochrane Systematic Review: Nerve blocks for initial pain management of femoral fractures in children

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Black KJ, Bevan CA, Murphy NG, Howard JJ

Objectives: To assess the effects (benefits and harms) of femoral nerve block (FNB) or fascia iliaca compartment block (FICB) for initial pain management of children with fractures of the femur (thigh bone) in the pre-hospital or in-hospital emergency setting, with or without systemic analgesia.

Systematic Review: A systematic review of faces scales for the self-report of pain intensity in children

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Tomlinson D, von Baeyer CL, Stinson JN, Sung L

Objectives: To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility.

Systematic Review: Pain management and sedation for children in the emergency department

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Atkinson P, Chesters A, Heinz P

We provide an overview of published evidence to help clinicians assess, manage, and minimise pain in children presenting to hospital.

Systematic Review: Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: A systematic review

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Castarlenas E, Jensen MP, von Baeyer CL, Mir J.

Objective: The Numerical Rating Scale-11 (NRS-11) is one of the most widely used scales to assess self-reported pain intensity in children, despite the limited information on its psychometric properties for assessing pain in pediatric populations. Recently, there has been an increase in published findings regarding the strengths and weaknesses of the NRS-11 as a measure of pain in youths. The purpose of this study was to review this research and summarize what is known regarding the reliability and validity of the NRS-11 as a self-report measure of pediatric pain intensity.

Cochrane Systematic Review: Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children

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Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoise...

Objective: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.

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

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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.

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

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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.

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 identify cocaine-free topically applied local anaesthetics that may provide equivalent analgesia to those containing cocaine.

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: Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties.

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Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN

Objectives: Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old. A secondary aim was to develop evidence-based recommendations for measurement of child and adolescent self-report of acute, postoperative, and chronic pain.

Systematic Review: How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review.

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Hartling L, Ali S, Dryden DM, Chordiya P, Johnson DW, Plint AC, Stang A, McGr...

We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings

Systematic Review: Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.

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Le May S,Ali S,Khadra C,Drendel AL,Trottier ED,Gouin S,Poonai N.

Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries.

Review: Treating abdominal pain in children: what do we know?

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Ali S, Sli H

Abdominal pain is a common reason for emergency department visits in the United States. Failure to treat children's pain has long been considered substandard and unethical. Within the emergency department setting, pain has been repeatedly shown to be undertreated. Analgesic medications are suboptimally used for children with abdominal pain because of a wide variety of causes. To our knowledge, there is no standard of care for the treatment of such pain. As such, several recent studies have set out to determine the most appropriate methods to address this gap in knowledge. The proceeding article will attempt to review the literature as it pertains to severe acute abdominal pain, biliary colic, renal colic, and dysmenorrhea.

Review: Pediatric pain management in the emergency department

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Bauman BH, McManus JG

In this article, the authors review the history of ED pediatric pain management and sedation, discuss special considerations in pediatric pain assessment and management, review various pharmacologic and nonpharmacologic methods of alleviating pain and anxiety, and present ideas to improve the culture of the pediatric ED, so that it can achieve the goal of becoming pain-free.

Review: Analgesics for the treatment of pain in children

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Berde CB, Sethna NF

Studies over the past 15 years suggest that neonates, infants, and children can receive analgesia and anesthesia safely, with proper age-related adjustments in clinical practice and dosing. Although the emphasis in this review is on the pharmacologic management of pain, several nonpharmacologic approaches, including hypnosis and related cognitive behavioral approaches, have had good efficacy in children with acute or chronic pain.5,6 Making the hospital environment a less terrifying place may reduce anxiety and fear, which can themselves exacerbate pain.7 Conversely, nonpharmacologic approaches should not be used as an excuse to withhold appropriate analgesics.

Systematic Review: Effectiveness of Probiotics in Children with Functional Abdominal Pain Disorders and Functional Constipation: A Systematic Review

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Wegh CAM,Benninga MA,Tabbers MM

The objective of this study was to investigate the effect of probiotics on functional abdominal pain disorders (FAPD) and functional constipation (FC).

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: 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.

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.

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 in infants.

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 child, parent and health professional outcomes and to synthesize this body of literature.

Key studies

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

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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: Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale-Revised and Color Analog Scale in Children With Acute Pain.

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Tsze DS, Hirschfeld G, Dayan PS, Bulloch B, von Baeyer CL.

The aims of this study were to define theFacesPainScaleRevised(FPS-R) andColor Analog Scale(CAS) scores associated with nopain, mildpain, moderatepain, and severepainin children with acutepain, and to identify differences based on age, sex, and ethnicity.

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

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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: Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale.

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Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, Msse B, Tsze ...

The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED)

Key Study: Etomidate versus midazolam for procedural sedation in pediatric outpatients: a randomized controlled trial

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Di Liddo L, D'Angelo A, Nguyen B, Bailey B, Amre D, Stanciu C

The objective of this study was to compare the efficacy of etomidate and midazolam for achieving procedural sedation and analgesia in children.

Key Study: Comparison of propofol/fentanyl versus ketamine/midazolam for brief orthopedic procedural sedation in a pediatric emergency department

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Godambe SA, Elliot V, Matheny D, Pershad J

This study compared the effectiveness of 2 medication regimens, propofol/fentanyl (P/F) and ketamine/midazolam (K/M), for brief orthopedic emergency department procedural sedation.

Key Study: Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

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Acworth JP, Purdie D, Clark RC

This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department.

Key Study: Safety and efficacy of propofol administered by paediatricians during procedural sedation in children

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Chiaretti A, Benini F, Pierri F, Vecchiato K, Ronfani L, Agosto C, Ventura A,...

The aim of this study was to determine the safety and the efficacy of paediatrician-administered propofol in children undergoing different painful procedures.

Key Study: Physiologic monitoring practices during pediatric procedural sedation: a report from the Pediatric Sedation Research Consortium

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Langhan ML, Mallory M, Hertzog J, Lowrie L, Cravero J

This study aimed to describe the frequency of different physiologic monitoring modalities and combinations of modalities used during pediatric procedural sedation and to describe the variations of monitoring and whether or not sedations meet monitoring guidelines.

Key Study: A blinded, randomized controlled trial to evaluate ketamine/propofol versus ketamine alone for procedural sedation in children

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Shah A, Mosdossy G, McLeod S, Lehnhardt K, Peddle M, Rieder M

This study compared total sedation time when ketamine/ propofol was used compared with ketamine alone for pediatric procedural sedation and analgesia.

Key Study: Characteristics of and Predictors for Apnea and Clinical Interventions During Procedural Sedation

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Krauss BS, Andolfatto G, Krauss BA, Mieloszyk RJ, Monuteaux MC

This study aims to describe the characteristics of and predictors for apnea and clinical interventions during emergency department (ED) procedural sedation.

Key Study: Parent and provider perspectives on procedural care for children with autism spectrum disorders

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Davignon MN, Friedlaender E, Cronholm PF, Paciotti B, Levy SE

The aim of this study was to identify parent and provider perspectives on barriers and facilitators to procedural care for children with autism spectrum disorders.

Key Study: Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures

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Morrison T, Carender C, Kilbane B, Liu RW

The current study was conducted to answer 2 questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation : 1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? 2) Is there a difference in the rates of major sedation-related complications?

Key Study: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?

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Hirsch, D G, Tyo, J and Wrotniak, B H

The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.

Key Study: Behavioral Changes in Children After Emergency Department Procedural Sedation

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Pearce, J I, Brousseau, D C, Yan, K, Hainsworth, K R, Hoffmann, R G and Drend...

The purpose of this study was to determine the proportion of children undergoing procedural sedation for fracture reduction in the emergency department (ED) observed to experience negative postdischarge behaviors. Predictors of negative behaviors were evaluated, including anxiety.

Key Study: Etomidate Versus Ketamine: Effective Use in Emergency Procedural Sedation for Pediatric Orthopedic Injuries

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Disel, N R, Yilmaz, H L, Sertdemir, Y, Yesilagac, H and Avci, A

The aim of this study was to compare the induction and recovery times, postsedation observation durations, and adverse effects of etomidate and ketamine in pediatric patients with fractures and/or dislocations requiring closed reduction in the emergency department.

Key Study: Extremity fracture pain after emergency department reduction and casting: predictors of pain after discharge

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Thompson, RW, Krauss, B, Kim, YJ, Monuteaux, MC, Zerriny, S, & Lee, LK

Objectives: To determine the prevalence of pediatric extremity fracture pain after emergency department (ED) discharge, compare pain severity between fractures requiring simple casting versus sedated reduction and casting, and explore predictors of postdischarge pain.

Key Study: Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department

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Bailey B, Bergeron S, Gravel J, Daoust R

Study Objective: In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED).

Key Study: The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement

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Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B

The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version.

Key Study: Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain.

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Tsze DS, Hirschfeld G, von Baeyer CL, Suarez LE, Dayan PS.

This was a crosssectional study of children 6 to 17 and 4 to 17 years old who were assessed using the Verbal Numerical Rating Scale (VNRS) and Faces Pain ScaleRevised (FPSR), respectively

Key Study: Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial

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Poonai N, Bhullar G, Lin K, Papini A, Mainprize D, Howard J, Teefy J, Bale M,...

Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.

Key Study: Pretreatment with intravenous ketamine reduces propofol injection pain

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Barbi E, Marchetti F, Gerarduzzi T, Neri E, Gagliardo A, Sarti A, Ventura A

The aim of the study was to investigate whether pretreatment with ketamine would reduce infusion line pain in propofol sedation in children.

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 decreased venipuncture pain in young children compared with vapocoolant spray.

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.

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

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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: 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

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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: Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

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Daoust R, Paquet J, Bailey B, Lavigne G, Piette E, Sanogo K, Chauny JM

Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain.

Key Study: Association of race and ethnicity with management of abdominal pain in the emergency department

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Johnson TJ, Weaver MD, Borrero S, Davis EM, Myaskovsky L, Zuckerbraun NS, Kra...

Objective: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs).

Key Study: Reliability of the visual analog scale in children with acute pain in the emergency department

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Bailey B, Gravel J, Daoust R

In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8-17 years presenting to a pediatric emergency department with acute pain.

Key Study: Pain assessment for children: overcoming challenges and optimizing care

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Drendel AL, Kelly BT, Ali S

This review will highlight the many complexities of the assessment of pain for the pediatric patient. In addition, a variety of factors that affect the self-report of pain in children will be identified.

Key Study: Pain management of musculoskeletal injuries in children: current state and future directions

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Ali S, Drendel AL, Kircher J, Beno S

Objectives: Upon completion of this CME article, the reader should be better able to (1) distinguish multiple nonpharmacological techniques for minimizing and treating pain and anxiety in children with musculoskeletal injuries, (2) apply recent medical literature in deciding pharmacological strategies for the treatment of children with musculoskeletal injuries, and (3) interpret the basic principles of pharmacogenomics and how they relate to analgesic efficacy.

Key Study: Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain

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Saunders M, Adelgais K, Nelson D

Objectives: The objective was to evaluate the use of a single 2 g/kg dose of intranasal fentanyl as analgesia for painful orthopedic injuries in children presenting to a pediatric emergency department (ED).

Key Study: A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain

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Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK

Study Objective: We compare the treatment of pain in children with arm fractures by ibuprofen 10 mg/kg versus acetaminophen with codeine 1 mg/kg/dose (codeine component).

Key Study: Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial

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Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR

Objectives: This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting.

Key Study: Oxycodone versus codeine for triage pain in children with suspected forearm fracture: a randomized controlled trial

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Charney RL, Yan Y, Schootman M, Kennedy RM, Luhmann JD

Objective: To compare the efficacy of pain reduction of triage oxycodone (O) versus codeine (C) to children with suspected forearm fractures.

Key Study: Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial

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Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A

Study Objective: The evidence supporting the use of analgesia in children with abdominal pain suggestive of appendicitis is limited. The objectives of the study are to evaluate the efficacy of morphine before surgical consultation in children presenting to the pediatric emergency department (ED) with right lower quadrant pain suggestive of appendicitis and determine whether it has an impact on the time between arrival in the ED and the surgical decision.

Key Study: A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department

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Borland M, Jacobs I, King B, O'Brien D

Study Objective: We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department (ED) with acute long-bone fractures.

Key Study: A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma

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Clark E, Plint AC, Correll R, Gaboury I, Passi B

Objective: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries.

Key Study: Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children

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Koller DM, Myers AB, Lorenz D, Godambe SA

Objective: Orthopedic injuries comprise a majority of the indications for analgesia in the emergency department. Oxycodone and ibuprofen have demonstrated efficacy for this indication, but no studies have compared these drugs in children. Our objective was to investigate the effectiveness of oxycodone, ibuprofen, or their combination for the management of orthopedic injury-related pain in children.

Key Study: Pain assessment for pediatric patients in the emergency department

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Drendel AL, Brousseau DC, Gorelick MH

Objective: To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.

Key Study: Early analgesia for children with acute abdominal pain

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Green R, Bulloch B, Kabani A, Hancock BJ, Tenenbein M

Objectives: The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain.

Key Study: Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy

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Kokki H, Lintula H, Vanamo K, Heiskanen M, Eskelinen M

Objective: To evaluate the effects of buccal oxycodone on pain relief, physical examination findings, diagnostic accuracy, and final clinical outcomes in children with acute abdominal pain.

Key Study: Emergency department analgesia for fracture pain

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Brown JC, Klein EJ, Lewis CW, Johnston BD, Cummings P

Study Objectives: We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities.

Key Study: A randomized clinical trial of analgesia in children with acute abdominal pain

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Kim MK, Strait RT, Sato TT, Hennes HM

Objective: To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain.

Key Study: The FLACC: a behavioral scale for scoring postoperative pain in young children

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Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S

Purpose: To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.

Key study: Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: study protocol for a cluster randomised controlled trial

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van Uum RT, Venekamp RP, Sjoukes A, van de Pol AC, de Wit GA, Schilder AGM, D...

Objective: We have developed a primary care-based multifaceted educational intervention to optimise pain management in children with AOM, and we trial its clinical and cost effectiveness.

Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department

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Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...

The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.

Key Study: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway

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Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M

This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

Key Study: A RCT of a Combination of Analgesics for Pain Management in Children With a Suspected Fracture

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Alam Khan, T, Jamil Khattak, Y, Awais, M, Alam Khan, A, Husen, Y, Nadeem, N a...

To assess the utility of trauma series radiographs in the management of alert pediatric patients with traumatic injury and to ascertain whether it is necessary to acquire the entire trauma series in these children.

Key Study: A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma

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Clark, E, Plint, AC, Correll, R, et al

To determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries.

Key Study: A comparison of pain assessment by physicians, parents and children in an outpatient setting

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Christina Brudvik,Svein-Denis Moutte, Valborg Baste,andTone Morken

Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.

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

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

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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

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

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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

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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

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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

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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

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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

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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

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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

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

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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

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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

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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

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

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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 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 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.

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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 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)

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.

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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 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

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 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

Emergency Medicine Cases Podcast: Pediatric abdominal pain & appendicitis

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Dr. Anna Jarvis & Dr. Stephen Freedman

Episode 19 Part 1:In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis & Dr. Stephen Freedman discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows. Published online: December 2011.  

Emergency Medicine Cases Podcast: Pediatric Pain Management

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Dr. Samina Ali & Dr. Anthony Crocco

Episode 67: Pain is the most common reason for seeking health care. It accounts for 80% of ED visits. The WHO has declared that “optimal pain treatment is a human right”. As has been shown in multiple ED-based Pediatric pain management studies, Pediatric pain is all too often under-estimated and under-treated. Why does this matter? Under-estimating and under-treating pediatric pain may have not only short term detrimental effects but life-long detrimental effects as well; not to mention, screaming miserable children disturbing other patients in your ED and complaints to the hospital from parents. Whether it’s venipuncture, laceration repair, belly pain or reduction of a fracture we need to have the skills and knowledge to optimize efficient and effective pain management in all the kids we see in the ED. What are the indications for intranasal fentanyl? intranasal ketamine? Why should codeine be contra-indicated in children? How do triage-initaited pain protocols improve pediatric pain management? Which are most effective skin analgesics for venipuncture? To help you make these important pediatric pain management decisions, in this podcast we have one of the most prominent North American researchers and experts in Emergency Pediatric pain management, Dr. Samina Ali and not only the chief of McMaster Children’s ED but also the head of the division of Pediatric EM at McMaster University, Dr. Anthony Crocco.

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 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.

TREKK.ca Info Pages

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Podcast: Pediatric Procedural Sedation

Posted: Feb 09, 2016  | Announcement  | Team: News and Events 
Tags: Procedural Sedation, Procedural Pain



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Canadian Paediatric Society Position Statement: Pain Management

Posted: Nov 05, 2019  | Announcement  | Team: News and Events 



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New Bottom Line Recommendation: Procedural Pain

Posted: Nov 07, 2016  | Announcement  | Team: News and Events 



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New resources available on trekk.ca!

Posted: Jul 10, 2015  | Resource  | Team: News and Events 



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News Story: Guidelines for managing child pain in the ED

Posted: Jul 15, 2016  | Announcement  | Team: News and Events 



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New Bottom Line Recommendation: Pain Treatment

Posted: Jul 16, 2018  | Announcement  | Team: News and Events 



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Learning to Live With Chronic Pain

Posted: Apr 11, 2017  | Announcement  | Team: News and Events 



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Congratulations Dr. Samina Ali!

Posted: Nov 19, 2018  | Announcement  | Team: News and Events 



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Pediatric Pain Letter

Posted: Nov 21, 2017  | Announcement  | Team: News and Events 



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Profiling pediatric pain expert: Dr. Samina Ali

Posted: Mar 18, 2016  | Announcement  | Team: News and Events 



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Constipation Resources in French

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NEW Parent Tools!

Posted: May 30, 2019  | Announcement  | Team: News and Events 



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Manitoba Pediatric Health Conference 2017

Posted: Mar 30, 2017  | Announcement  | Team: News and Events 



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Parent tools - UTI and Bronchiolitis

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Parent tools - CTV Winnipeg

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2017 Pediatric Emergency Care Conference

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New bottom line recommendations for concussion on trekk.ca

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I Love to Read Month

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