Agreement between child self-reported and parent-reported scores for chronic pain secondary to specific pediatric diseases. / Concordancia en pacientes con dolor crónico secundario a enfermedades pediátricas entre la autovaloración y las puntuaciones reportadas por sus padres.

BACKGROUND: Parental report on a child's secondary chronic pain is commonly requested by anesthesiologists when the child cannot directly provide information. Daily pain intensity is reported as highest, average and lowest. However, it is unclear whether the parents' score is a valid indicator of the child's pain experience. METHODS: Nineteen children (aged 6-18years) with secondary chronic pain attending our anesthesiologist-run pediatric pain unit participated in this study. Identification of highest, average and lowest pain intensity levels were requested during initial screening interviews with the child and parents. Pain intensity was scored on a 0-10 numerical rating scale. Agreement was examined using: (i) intraclass correlation coefficient (ICC), and (ii) the Bland-Altman method. RESULTS: The ICC's between the children and the parents' pain intensity reports were: 0.92 for the highest, 0.68 for the average, and 0.50 for the lowest pain intensity domains. The limits of agreement set at 95% between child and parental reports were respectively +2.19 to -2.07, +3.17 to -3.88 and +5.15 to -5.50 for the highest, average and lowest pain domains. CONCLUSIONS: For the highest pain intensity domain, agreement between parents and children was excellent. If replicated this preliminary finding would suggest the highest pain intensity is the easiest domain for reporting pain intensity when a child cannot directly express him or herself.

[Usefulness of radiologic monitoring of epidural catheters using epidurography]. / Utilidad del control radiológico de los catéteres epidurales mediante epidurografía.

INTRODUCTION: Peridural analgesia involves a segmental block which at the thoracic level allows for early pulmonary recovery after chest or high abdominal surgery. The approach is difficult in children for reasons related to anatomy, maintenance, insertion of the catheter and dosing. OBJECTIVE: To report the radiologic monitoring of epidural catheter placement by epidurography as a technique for placing the epidural catheter in 17 patients for whom postoperative analgesia was to be provided by the same route. PATIENTS AND METHODS: Eighteen children (aged from 2 to 12) were given general anesthesia followed by epidural anesthesia. After catheterization of the epidural space, 1 or 1-5 ml of contrast was injected. Immediately afterwards an X-ray of the thoracic or lumbar spinal column, as appropriate to each case, was obtained. Epidural analgesia was provided with a mixture of bupivacaine 0.125% and fentanyl, in continuous perfusion or in fractionated doses. RESULTS: Placement of the catheter tip was confirmed in 17 cases by visualization of symmetry and the presence of contrast medium in the epidural space. In one case we observed extravasation of contrast medium, which had invaded the paravertebral space. The course was linear in 17 cases, with no looping. No complications related to injection of contrast medium were observed. CONCLUSIONS: Epidurography provides objective monitoring of tip placement and trajectory of epidural catheters, advantages which argue in favor of more frequent application of this imaging technique.