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Azemati S, Keihani M, Sahmeddini MA, Kanaani Nejad F, Dehghanpisheh L, Khosravi MB, Asmarian N. Comparing the Sedative Effects of Intranasal Dexmedetomidine, Midazolam, and Ketamine in Outpatient Pediatric Surgeries: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:421-429. [PMID: 39114639 PMCID: PMC11300945 DOI: 10.30476/ijms.2023.99122.3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 08/10/2024]
Abstract
Background The management of preoperative anxiety in pediatric patients, as well as its implications, has remained challenging for anesthesiologists. In this study, we compared the safety and efficacy of intranasal dexmedetomidine, midazolam, and ketamine as surgical premedication in children. Methods This double-blinded randomized clinical trial was conducted at two tertiary hospitals in January 2014, on 90 children aged between 2-7 years old. The participants' American Society of Anesthesiologists (ASA) physical status was I or II, and they were scheduled for elective unilateral inguinal herniorrhaphy. Using the block randomization method, the patients were randomly assigned to three groups, each receiving intranasal dexmedetomidine (2 µg/Kg), midazolam (0.2 mg/Kg), and ketamine (8 mg/Kg) 60 min before induction of anesthesia. Anxiety and sedation state were evaluated before drug administration, and then every 10 min for the next 50 min. Parental separation anxiety, mask acceptance, postoperative agitation, pain, nausea, and vomiting were also recorded and compared between these groups. All the statistical analyses were performed using SPSS software (version 21.0). P<0.05 was considered statistically significant. Results Ketamine indicated the strongest sedative effect 10, 20, and 30 min after administration of premedication (P<0.001, P=0.03, P=0.01, respectively). However, dexmedetomidine was more effective than other drugs after 40 and 50 min (P<0.001). Other variables indicated no statistically significant difference. Conclusion In case of emergencies, intranasal ketamine, with the shortest time of action, could be administered. Intranasal dexmedetomidine, which was revealed to be the most potent drug in this study, could be administrated 40-50 min before elective pediatric surgeries.Trial registration number: IRCT2013081614372N1.
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Affiliation(s)
- Simin Azemati
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Keihani
- Hazrat Zeinab Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sahmeddini
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Kanaani Nejad
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Dehghanpisheh
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bagher Khosravi
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ghouri N, Mushtaq M. Breaking barriers: Exploring the Full Cup Test (FCT) pain scale at a tertiary care hospital. Pak J Med Sci 2024; 40:S35-S41. [PMID: 38328655 PMCID: PMC10844905 DOI: 10.12669/pjms.40.2(icon).8944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/25/2023] [Accepted: 10/28/2023] [Indexed: 02/09/2024] Open
Abstract
Background and Objective Pain assessment plays a vital role in the management of patients across various healthcare settings. Accurate and reliable pain evaluation tools are essential for effective pain management and improving patient outcomes. The objective of this study was to assess ease of Full Cup Test (FCT) as a pain scale and to compare use of FCT with Visual Analogue Scale (VAS) for pain evaluation. Methods A cross-sectional study carried out at a tertiary care hospital from December 2021 to July 2022 on individuals with pain at various body locations. Pain severity was evaluated using two pain assessment tools, the FCT and the VAS. The main objectives of the study were to assess correlation and agreement between the FCT and VAS; using Kappa statistics. Results Of the total 288 subjects, median age was 42.5 years (IQR: 13-78), and median duration of pain was four months (IQR: one day to forty years). Analysis revealed significant positive correlation (r=0.577) between the Full Cup Test (FCT) and the Visual Analog Scale (VAS), indicating a relationship between both pain assessment tools. Significant agreement was also observed between FCT and VAS, with a kappa value of 0.596 (p<0.0001). Results however indicated that illiterate patients found it easier to understand FCT compared to VAS. Conclusion The Full Cup Test (FCT) emerged as a potentially valuable tool for assessing pain severity in a diverse range of patients. Regardless of age, gender, education level, and ethnicity, FCT demonstrated utility with ease in detecting pain severity.
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Affiliation(s)
- Nida Ghouri
- Nida Ghouri, Office of Research, Innovation and Commercialization (ORIC) Indus Hospital & Health Network, Karachi, Pakistan
| | - Maria Mushtaq
- Maria Mushtaq, Office of Research, Innovation and Commercialization (ORIC) Indus Hospital & Health Network, Karachi, Pakistan
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Gawe ZA, Isa HM, Almashaur MM, Haider F, Almulla K. The Effect of Caudal Anesthesia Block on Perioperative Pain Control and Reduction of the Anesthetic Agent in Pediatric Infraumbilical Surgery: A Prospective Randomized Trial Study. Anesth Essays Res 2022; 16:301-306. [PMID: 36620118 PMCID: PMC9813991 DOI: 10.4103/aer.aer_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022] Open
Abstract
Background Caudal epidural block (CEB) is a commonly performed neuraxial block to provide effective pain relief and analgesia in pediatric patients undergoing infraumbilical surgery. Aims This study aimed to compare the effectiveness of adding CEB to general anesthesia (GA) in terms of intra- and postoperative pain management. Design Prospective, randomized case-controlled trial study. Setting Operation theater, and postoperative recovery rooms at Salmaniya Medical Complex, Bahrain. Materials and Methods A total of 74 patients aged 2 months to 6 years with American Society of Anesthesiologists physical status classification I were recruited over a 6-month period between December 2019 and May 2020. Patients were allocated into two groups (Group A, with CEB) or (Group B, without CEB). Both groups were compared based on hemodynamic stability, pain scores, level of sedation, analgesia need, and parental satisfaction. Statistical Analysis Data were analyzed using SPSS program. Categorical and numerical variables of both the groups were compared. Results Patients with CEB had better hemodynamic stability during the surgical procedure based on heart rate (P = 0.039). Pain intensity scores were less in patients with CEB than those without (P < 0.001). Fentanyl consumption was lower in Group A compared to Group B at the end of surgery (P = 0.002). They were also ambulated earlier and discharged sooner than those without CEB. Parental satisfaction was 92.1% in Group A compared to 63.9% in Group B (P = 0.012). Conclusions Adding CEB to GA for intraoperative and perioperative pain control in pediatric patients undergoing infraumbilical surgery makes it more effective, safe, and with better parental satisfaction.
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Affiliation(s)
- Zeana Amer Gawe
- Department of Anesthesia, Salmaniya Medical Complex, Government Hospital in Bahrain, Manama, Bahrain
| | - Hasan Mohamed Isa
- Department of Pediatric, Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain
| | | | - Fayza Haider
- Department of Surgery, Salmaniya Medical Complex, Arabian Gulf University, Manama, Bahrain
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Sasidharan S, Dhillon G, Dhillon H, Manalikuzhiyil B. Scales for assessment of pain in infants, neonates and children. ADVANCES IN HUMAN BIOLOGY 2021. [DOI: 10.4103/aihb.aihb_109_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:257-263. [PMID: 32551155 DOI: 10.5606/tgkdc.dergisi.2020.19104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/22/2020] [Indexed: 02/06/2023]
Abstract
Background In this study, we evaluated the efficacy of intercostal nerve block for postoperative pain management in pediatric patients undergoing atrial septal defect closure through a right lateral mini-thoracotomy. Methods Between January 2016 and January 2019, a total of 63 pediatric patients (37 males, 26 females; mean age 34.8±26.8 months; range, 2 to 96 months) who underwent corrective congenital heart surgery for atrial septal defect closure through a right lateral mini-thoracotomy were retrospectively reviewed. The patients were divided into two groups as those (Group 1, n=33) receiving intercostal nerve block and general anesthesia and those (Group 2, n=30) receiving general anesthesia alone. Intravenous morphine at a dose of 0.03 mg/kg was applied as rescue analgesia to the patients with a Ramsay Sedation Scale score of >4 and Children"s Hospital of Eastern Ontario Pain Scale score of >7. The total analgesic requirement, adverse effects, duration of mechanical ventilation and length of stay in the intensive care unit were recorded. Results The mean duration of mechanical ventilation and intensive care unit stay was shorter in Group 1 compared to Group 2 (3.6±1.3 vs. 9.4±2.1 h; 23±2.6 vs. 30±7.2 h, respectively) (p<0.0001). The need for postoperative rescue analgesia was statistically significantly lower in Group 1 compared to Group 2 (0.3±0.5 mg vs. 1.1±0.9 mg, respectively) (p=0.003). The mean total morphine consumption was also lower in Group 1 compared to Group 2 (4.0±2.2 mg vs. 9.0±3.4 mg, respectively) (p<0.0001). Conclusion Intercostal nerve block before thoracotomy closure in pediatric patients undergoing atrial septal defect repair under mini-thoracotomy provides early extubation, shorter mechanical ventilation duration and intensive care unit stay, and reduced analgesic requirements.
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O'Neal K, Olds D. Differences in Pediatric Pain Management by Unit Types. J Nurs Scholarsh 2016; 48:378-86. [PMID: 27275945 DOI: 10.1111/jnu.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to determine differences in pediatric pain management by unit type in hospitals across the United States. The aims were to (a) compare unit-type rates of assessment, intervention, and reassessment (AIR), and (b) describe differences in assessment tools and intervention use by unit type. DESIGN The study used a cross-sectional design. A secondary analysis of 2013 data from the National Database of Nursing Quality Indicators (NDNQI®) pain AIR cycle indicator was conducted. The sample included 984 pediatric units in 390 hospitals. METHODS Data were gathered via retrospective chart review on the pain assessment tool used, presence of pain, interventions, and reassessment. Descriptive statistics and the Kruskal-Wallis one-way analysis of variance test were conducted. Post-hoc analyses included the Wilcoxon-rank sum test with Bonferroni correction. FINDINGS Across all units the mean unit-level percentage of patients assessed for pain was 99.6%. Of those patients assessed, surgical units had the highest average unit-level percentage of patients with pain, while Level 4 neonatal intensive care units (NICUs) had the lowest. The most commonly used assessment tool among all units was the Faces, Legs, Activity, Crying, and Consolability (FLACC) Scale. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and Neonatal Infant Pain Scale (NIPS) specifically developed for infants were more commonly used across NICU unit types. The mean unit-level percentage of patients with pain receiving an intervention was 89.4%, and reassessment was 83.6%. Overall, pharmacologic methods were the most common pain intervention, while music was the least common. CONCLUSIONS Assessments were performed routinely, yet interventions and reassessments were not. Pain AIR cycle completion varied by unit type. Pain was also widely present across many unit types, and pharmacologic methods were most frequently used. CLINICAL RELEVANCE Frontline nurses are instrumental to pain management and have the ability to improve patient care and outcomes by effectively managing pain. A comprehensive understanding of it provides valuable insight into improving our practice to produce the best outcomes for pediatric patients.
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Affiliation(s)
- Kelsea O'Neal
- Delta, Staff Nurse, Children's Mercy Hospitals and Clinics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Danielle Olds
- Alpha Mu, and Delta, Research Assistant Professor, University of Kansas School of Nursing, Kansas City, KS, USA
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Li X, Zhou M, Xia Q, Li J. Parecoxib sodium reduces the need for opioids after tonsillectomy in children: a double-blind placebo-controlled randomized clinical trial. Can J Anaesth 2015; 63:268-74. [PMID: 26684457 DOI: 10.1007/s12630-015-0560-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/14/2015] [Accepted: 12/03/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Postoperative pain is a common phenomenon after pediatric tonsillectomy. This prospective randomized double-blind placebo-controlled clinical trial was performed to evaluate the analgesic efficacy of intravenous parecoxib sodium in children undergoing tonsillectomy. METHODS Sixty children (American Society of Anesthesiologists physical status I-III, aged three to seven years, and scheduled to undergo elective tonsillectomy under general anesthesia) were randomly allocated into one of two groups to receive intravenous parecoxib sodium 1 mg·kg(-1) (Group P, n = 30) or the same volume of saline (Group S, n = 30) just after induction of general anesthesia. Between-group comparisons were made for the number of patients requiring rescue morphine, total number of doses of postoperative rescue morphine, time to first rescue analgesic, postoperative pain and sedation scores, and adverse effects. RESULTS Rescue morphine was given to more children in Group S (25/30, 83%) than in Group P (17/30, 57%) [relative risk (RR), 1.5; 95% confidence interval (CI), 1.0 to 2.1; P = 0.024]. The mean (SD) time to first rescue analgesic was shorter in Group S than in Group P [132 (54) min vs 193 (78) min, respectively; mean difference, 61; 95% CI, 26.6 to 96.1; P = 0.001]. The median (interquartile range [IQR]) Children's Hospital of Eastern Ontario Pain Scale scores in the postanesthesia care unit were lower in Group P than in Group S (7 [5-8] vs 9 [8-11], respectively; P = 0.001). The incidence of postoperative nausea and vomiting (PONV) was higher in Group S than in Group P [11/30 (37%) vs 4/30 (13%), respectively; RR, 2.8; 95% CI, 1.0 to 7.7; P = 0.037]. CONCLUSIONS A single intravenous injection of parecoxib sodium 1 mg·kg(-1) after anesthesia induction is an effective method for the control of postoperative pain. It provides a morphine-sparing effect, prolongs the time to first rescue analgesic, and reduces PONV in children undergoing tonsillectomy.
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Affiliation(s)
- Xiuze Li
- Department of Anesthesiology, Mianyang Central Hospital, 12 Changjia Lane, Mianyang, 621000, Sichuan, China.
| | - Mengjun Zhou
- Department of Health Statistics, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Qing Xia
- Department of Anesthesiology, Mianyang Central Hospital, 12 Changjia Lane, Mianyang, 621000, Sichuan, China
| | - Juan Li
- Department of Anesthesiology, Mianyang Central Hospital, 12 Changjia Lane, Mianyang, 621000, Sichuan, China
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