Manejo de dolores habituales infantiles por pediatras de nuestro ámbito / Management of usual pediatric pain according to pediatricians within our community

Objetivo: Valorar la práctica clínica de un colectivo de pediatras de dolores frecuentes en los niños. Sujetos y métodos: Estudio descriptivo realizado a través de encuesta por correo a los 686 miembros de la Sociedad de Pediatría de Asturias, Cantabria, Castilla y León. La encuesta contiene 20 preguntas dirigidas a investigar si los profesionales aplican la analgesia en dolores agudos y crónicos en su práctica clínica habitual. Resultados: Se recibieron 157 encuestas contestadas (23 por ciento). La formación recibida sobre analgesia es considerada escasa o inexistente en el 90 por ciento de las respuestas recibidas. El 60 por ciento de los pediatras hospitalarios indican analgesia en la amigdalitis aguda, el 70 por ciento en la otitis media aguda, el 30 por ciento en la enfermedad inflamatoria intestinal y el 24 por ciento lo hace en los dolores osteoarticulares, mientras que los pediatras de atención primaria lo hacen en el 91 por ciento, 85 por ciento, 15 por ciento y el 45 por ciento respectivamente de las mismas enfermedades. Los pediatras mayores de 45 años, en relación al grupo de menor edad, indican analgésicos en la erupción dental en el 24 por ciento vs 50 por ciento, en las amigdalitis agudas en el 73 por ciento vs 80 por ciento, en la extracción dental en el 35 por ciento vs 53 por ciento, en el 59 por ciento vs 75 por ciento de las quemaduras de 2º y en el 33 por ciento vs 16 por ciento de los casos de enfermedad inflamatoria intestinal. El 53 por ciento de las mujeres indica analgesia en la erupción dental, en el 15 por ciento de las amigdalitis agudas y en el 79 por ciento de las quemaduras de 2º y sólo el 32 por ciento, 5 por ciento y 62 por ciento de los varones o hacen. Conclusiones: Parece existir mayor atención en el tratamiento del dolor agudo entre los pediatras de atención primaria y se observa cómo los más jóvenes son más conscientes del dolor y lo tratan con mayor frecuencia, probablemente en relación con una mejor formación sobre el tema. Existe mayor sensibilidad al dolor entre las pediatras mujeres. Es necesario mejorar la formación sobre la aplicación de la analgesia en el campo de la pediatría (AU)

[Pediatricians' opinion on sedation in children]. / Opinión de los pediatras sobre la sedación en los niños.

OBJECTIVE: Our objective was t evaluate the current knowledge and attitudes of pediatricians regarding the issue of pediatric sedation. PATIENTS AND METHODS: In October 1996 we conducted a mail survey of all 686 members of the Asturias, Cantabria and Castilla y Leon Pediatric Society. Physicians were asked to complete and return a confidential 18-item questionnaire. RESULTS: One hundred fifty-seven (23%) of the eligible physicians responded. Of the responding physicians, 90% agreed that they had insufficient training in pain and sedation management. Seventeen percent thought childhood sedation to be very effective, 76% effective and 7% little effective. Fifty-nine percent thought infant sedation was easy and 36% considered it to be difficult. Thirty-six percent of the pediatricians who work in hospitals considered the cooperation of children under 8 to be good versus only 17% of the primary attention pediatricians (p < 0.05). Thirty-nine percent thought that it was only necessary on some occasions that the parents are present when the child is sedated before surgery. Forty-eight percent of the male pediatricians considered that sedation was always or almost always indicated versus 67% of the female pediatricians (p < 0.05). The most used sedative drugs are midazolam (24%), diazepam (23%) and chloral hydrate (14%). Eleven percent indicated that it was necessary to monitor cardiorespiratory function and oxygen saturation during sedation. CONCLUSIONS: Pediatricians in this Society seem to have a lack of knowledge concerning sedation of their patients. Training in childhood sedation is needed.

[The opinion of pediatricians on childhood pain]. / Opinión de los pediatras sobre el dolor infantil.

OBJECTIVE: The objective of this study was to evaluate the current sensibility and knowledge of pediatricians regarding the issue of pediatric pain assessment and management. PATIENTS AND METHODS: In October 1996 we conducted a mail survey of all 686 members of the Asturias, Cantabria and Castilla y León Pediatric Society. Physicians were asked to complete and return a confidential 95-item questionnaire. RESULTS: One hundred fifty-seven (23%) of eligible physicians responded. Ninety percent of the respondents agreed they had insufficient training in pain management. Sixty-nine percent though their knowledge to deal with acute pain was adequate. Only 12% admitted to having enough background to treat chronic pain. Sixty-five percent of the respondents admitted to know no method at all for pain evaluation, while 82% had never applied any in their clinical practice. About half the respondents (42%) did not know any guidelines for the management of pediatric pain, although 75% considered they would be very useful. A high percentage of pediatricians answered that analgesia was required before performing certain diagnostic or therapeutic procedures (lumbar puncture, venous canalization, arterial puncture and others), but differences in relation to age, sex and clinical setting of the physicians were detected in these responses. The most used drug for the treatment of moderate acute pain is acetaminophen (88%), for severe acute pain metamizol (58%) and for severe chronic pain acetaminophen-codeine (37%). Only 48% admitted to having used opioids. CONCLUSIONS: Pediatricians in this society seem to be too confident about the topic of acute pain management in their patients, even though they report a lack of training which could influence the quality of the care they are offering to their patients. Opioid use is very low. Training in childhood pain management is needed.