ABSTRACT
This study assessed the reliability, validity, and responsiveness of a new pain measure for children aged 1 to 4 years that was developed from the Children's Hospital of Ontario Pain Scale and its Neonatal Infant Pain Scale. Pain in 311 children, aged 1 to 4 years, was measured by two observers at fixed intervals after adenotonsillectomy (n = 114), adenotomy (n = 109), or insertion of ventilation tubes (grommets) (n = 88) until discharge using a dichotomous pain scale of 9 behavioral and physiological categories. The scale proved to be strongly homogeneous. The interobserver agreement was substantial for 7 items. On these final 7 items, the ability to distinguish between patients with differing degrees of pain and the sensitivity to detect changes over time within each patient were substantial. The resulting Pain Observation Scale for Young Children is reliable and easy to use for assessment of short- and longer-lasting pain after ear, nose, and throat surgery and may be used for assessing pain with other conditions.
Subject(s)
Adenoidectomy/adverse effects , Middle Ear Ventilation/adverse effects , Pain Measurement/methods , Pain, Postoperative/diagnosis , Tonsillectomy/adverse effects , Adenoids/surgery , Child, Preschool , Female , Humans , Male , Observer Variation , Pain Measurement/standards , Reproducibility of ResultsSubject(s)
Pain Measurement , Pain/prevention & control , Child , Child, Preschool , Humans , Patient Care TeamSubject(s)
Analgesia/methods , Pain, Postoperative/therapy , Adolescent , Analgesia/standards , Child , Child, Preschool , Clinical Protocols , Humans , Pain MeasurementABSTRACT
Postoperative pain management is an area where preventive measures must be possible. This management will be linked to the expected pain in the postoperative period. To get a better insight in the expectancies and given treatment an inquiry was held in three Dutch hospitals. Of 48 often performed operative procedures in children only in 9 cases agreement was achieved. As a consequence treatment options were divers. Undertreatment is not unlikely. Postoperative pain scores by nurses was in 15 of 48 operative procedures significant higher than those by doctors.
Subject(s)
Pain, Postoperative/prevention & control , Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Nurses , Pain Measurement , Pain, Postoperative/diagnosis , Physicians , Pilot ProjectsABSTRACT
By means of multidisciplinary Pediatric Pain Groups in hospitals possibilities are created to implement recent knowledge about prevention of pain and relief of pain in children. The activities of these groups are amongst others: developing and testing pain protocols, applying systematic pain assessment and giving information about pediatric pain. These activities result in a reduction of pain in children and in prevention of needless suffering of pain in hospitalized children.
Subject(s)
Analgesia/methods , Pain Management , Patient Care Team , Adolescent , Child , Child, Hospitalized , Child, Preschool , Clinical Protocols , Humans , Netherlands , Pain/diagnosis , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/therapyABSTRACT
Pain prevention and analgesia in (adeno)tonsillectomy OBJECTIVE. To study the efficacy of three analgesia protocols in children subjected to (adeno)tonsillectomy. SETTING. Twenteborg District Hospital, Almelo, the Netherlands. PATIENTS AND METHODS. In 64 children with body weights ranging from 15 to 25 kg (mean 20.4 kg) subjected to (adeno) tonsillectomy according to the procedure most current in the Netherlands (according to Sluder with administration of a volatile anaesthetic without intubation in day treatment), three protocols for preventing and treating postoperative pain were applied, with the analgetics most current in the Netherlands. Permission from the Medical Ethical Committee and written informed consent from the parents were obtained. According to protocol I 240 mg paracetamol was given, according to protocol II, 500 mg paracetamol and according to protocol III, 500 mg paracetamol plus 10 mg codeine, in suppository form, every 4 hours always starting 60 minutes before operation. Initially, protocol I was carried out, subsequently randomization of protocols II and III. After a pilot study use of a control group was omitted for ethical reasons because of the severe pain in a placebo group. MEASUREMENTS. The efficacy of the analgesia was evaluated by means of pain assessments by the children themselves using the Oucher test, 1, 3 and 6 hours after operation. The statistical processing of the children's pain scores was performed primarily in a descriptive sense, with simultaneous comparison of the three groups using a single variance analysis for comparison of several groups. Multiple comparisons were carried out according to Ducans' multiple range test. The level of significance was put at p less than or equal to 0.05. RESULTS. One hour postoperatively there was no significant difference among the mean pain scores (0: no pain and 10: very bad pain) of the three groups, viz. 5.2 (SD 3.0), 4.7 (SD 2.9) and 4.7 (SD 2.3), respectively; three hours postoperatively there was a significant difference between the mean pain scores of group I (4.5; SD 2.4) and group II (2.7; SD 2.4) but not between group I and group III (3.3; SD 1.5); six hours postoperatively there was a significant difference between the mean pain scores of group I (4.1; SD 2.1) on the one hand and of groups II (2.1; SD 1.5) and III (2.6; SD 1.6) on the other. CONCLUSION. The findings indicate existence of violent pain immediately after recovery from anaesthesia after (adeno)tonsillectomy as shown by the pain assessments by the children themselves one hour postoperatively, in spite of preventive administration of a high dose of a 'minor' analgetic according to each of the three protocols. Modification of the anaesthetic technique should be considered to effect adequate prevention or suppression of pain.
