Validity and reliability of a Swedish version of the Non-Communicating Children's Pain Checklist--Postoperative Version.

AIM: To test the validity and reliability of a Swedish version of the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV). METHODS: Thirty-two consecutive children/adolescents (2-20 years of age) with cognitive impairment and no verbal communication from four habilitation centres were admitted to the study. Each child's behaviour was observed by a parent or a caregiver and by a physiotherapist in two calm and two painful situations within the child's everyday life. The raters independently assessed and graded the child's behaviour during 5 min according to the translated Swedish version of the NCCPC-PV. The intrarater and interrater reliability were determined, and the construct validity was examined. RESULTS: The results from 202 assessments showed that the construct validity was good: children's behavioural signs differed significantly between situations of pain and situations of calm (p < 0.001). Repeated assessments showed poor agreement both within and between raters [intraclass correlation coefficient (ICC) 0.51-0.65]. The agreement for pain was good (ICC 0.83). CONCLUSION: The Swedish version of the NCCPC-PV can be used for pain assessment in children with cognitive impairments who lack verbal communication. Aspects of reliability need to be further analysed.

Comparison of the analgesic efficacy of ketobemidone and morphine for management of postoperative pain in children: a randomized, controlled study.

BACKGROUND: Ketobemidone has been used as an analgesic for postoperative pain in children, but to our knowledge the effect and occurrence of adverse effects of ketobemidone compared to morphine is not known. The aim was to determine if the analgesic potency and the occurrence of adverse effects of ketobemidone differ from morphine when administered to children, as measured by patient-controlled analgesia consumption (PCA) for postoperative pain. METHODS: Sixty healthy children, aged 6 to 16 years, scheduled for elective surgery were randomized to receive either ketobemidone (Ke) 1 mg ml(-1) or morphine (Mo) 1 mg ml(-1) for postoperative pain through PCA. Drug consumption (microg kg(-1) h(-1)), the number of PCA doses, pain intensity, and adverse effects were recorded at regular intervals. RESULTS: Data on total drug consumption were based on 26 children in the Ke group and 28 in the Mo group. A non-statistically significant difference for total mean consumption of ketobemidone (18.6 microg kg(-1)h(-1)) and morphine (23.2 microg kg(-1)h(-1)) was obtained. The mean dose ratio (Mo/Ke) was 0.80 and the median was 0.94. Children's characteristics, loading dose, PCA doses, VAS scores, and adverse effects showed no significant differences between the groups. CONCLUSION: The analgesic potency and adverse effects of ketobemidone are similar to morphine when used for postoperative pain management in children.

Retrospective evaluation of continuous epidural infusion for postoperative pain in children.

BACKGROUND: The safety and efficacy of postoperative epidural analgesia (EDA) in children are not well documented in larger series of patients given routine postoperative care. The aims of this study were to evaluate the efficacy of pain relief, determine the incidence and type of complications during the entire period of epidural pain treatment in children, and assess the factors affecting efficacy METHODS: Children treated postoperatively with an EDA infusion during the period 18 September 1994 to 1 January 1999 were studied. Data regarding the age, gender, efficacy of analgesia, duration of epidural infusion, types of side-effects and complications, reasons for discontinuation, and types and duration of surgery were collected daily by the Acute Pain Treatment Service. The sensory dermatomal level of the surgical incision site was included retrospectively. RESULTS: Five hundred and eighteen epidural infusions were given to 476 children. Pain relief was rated as 'good' at 76% of visits. There were no major complications or sequelae. Thirty-seven per cent of the epidural infusions were prematurely discontinued, and 21% were discontinued because of unsatisfactory analgesia. Factors related to a higher percentage of unsatisfactory function were surgical incision site located above the umbilicus, gastroenterologic surgery, protracted surgery and age. Age and duration of surgery were significantly related to unsatisfactory function. CONCLUSION: This study shows that continuous epidural infusion for postoperative pain was satisfactory in most cases, and that no major side-effects or complications occurred in children nursed on regular wards. The early recognition of unsatisfactory function of an EDA is important for a child's well being.

Procedural pain in a paediatric surgical emergency unit.

Pain induced by various types of procedures was assessed in the Paediatric Surgical Emergency Department at St Göran's Children's Hospital in Stockholm. Assessments of pain were obtained from the nurse, the parent, and children over 10 years of age by means of a visual analogue scale. In children aged 3-9 years, the Smiley Five-Face Scale was used. The nurse and the parent also answered questionnaires about analgesic medication, the child's behaviour, and the parent's overall opinion of the pain management, etc. Irrigation of the glans penis because of balanitis, treatment of fractures and paronychia were considered to be the most painful procedures. Forty-four per cent of the children cried during the procedure and 16% fought against being restrained. In 24% of the cases, the child was judged to be in a state of "panic". In conclusion, we believe that the pain induced by procedures in the emergency rooms is unacceptably high. Children estimate higher pain scores than parents and nurses do. There was a poor correlation between the parent's and child's estimates of pain. Parents are not well informed about the possibilities for pain treatment. Infants and children attending emergency rooms must also benefit from recent advances in the treatment of pain.

Does a local anaesthetic cream (EMLA) alleviate pain from heel-lancing in neonates?

EMLA cream is an effective local anaesthetic agent for venipunctures in adults and children. The aim of this double-blind, randomised, and placebo-controlled study was to evaluate the effect of EMLA when heel-lancing was performed in neonates. On their third day of life, fullterm healthy infants, who underwent testing for phenylketonuria (PKU) by heel-lancing, were consecutively included in the study. One hundred and twelve neonates were allocated to eight groups according to the application time of EMLA or placebo (10 to 120 minutes). Thus in each group seven infants received active substance and seven placebo. The response to the nociceptive stimulation was assessed by studying the occurrence of a pain cry. No analgesic effect of EMLA was found. There were no adverse effects.