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Painful Procedures (painful + procedure)

Distribution by Scientific Domains

Medical Sciences	76%

Selected Abstracts

How painful are amniocentesis and chorionic villus sampling?,

PRENATAL DIAGNOSIS, Issue 1 2006
Akos Csaba
Abstract Objectives To compare the levels of pain and anxiety associated with amniocentesis (AC), transabdominal chorionic villus sampling (TA-CVS), and transcervical chorionic villus sampling (TC-CVS). Methods We prospectively administered a questionnaire about pain and anxiety to 124 women undergoing AC, 40 undergoing TA-CVS, and 24 undergoing TC-CVS for singleton pregnancies. The level of pain was quantified with numerical and pictorial scales and the degree of anxiety was quantified with a numerical scale (0,100 in increments of 10). Results The mean pain score for TA-CVS, 41.4 ± 18.1, was significantly higher than that for TC-CVS, 26.4 ± 25.3, p = 0.008. The mean pain score for AC, 35.1 ± 27.6, was intermediate. A higher degree of anxiety was associated with younger maternal age and nulliparity. A higher degree of anxiety was associated with a higher level of pain. Conclusion In general, each procedure is associated with a tolerable amount of pain. TA-CVS appears to be the most painful procedure while TC-CVS appears to be the least painful procedure. In certain groups of patients, the procedures may be associated with higher levels of pain and/or anxiety. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Postoperative Pain and Side Effects After Uvulopalatopharyngoplasty, Laser-Assisted Uvulopalatoplasty, and Radiofrequency Tissue Volume Reduction in Primary Snoring

THE LARYNGOSCOPE, Issue 12 2003
Philippe Rombaux MD
Abstract Objectives We compared, in a prospective study, the side effects and the postoperative complications of three procedures commonly used for the treatment of primary snoring. Method Forty-nine patients underwent velopharyngeal surgery for primary snoring (17 for uvulopalatopharyngoplasty [UPPP]; 15 for laser-assisted uvulopalatoplasty [LAUP], and 17 for radiofrequency tissue volume reduction [RFTVR]). Preoperative full polysomnographic studies ruled out obstructive sleep apnea syndrome. Each patient's evaluation encompassed postoperative pharyngeal pain (as measured by a 5-point visual analogue scale) and use of narcotic drugs in the early postoperative period as well as a subjective evaluation of late postoperative complaints. A surgeon's examination was performed to report postoperative complications in the oropharynx. Results Postoperative pharyngeal pain was less important in the RFTVR group than in the UPPP and LAUP groups. Mean scores at days 3, 7, 16 were as follows: 4.2, 4.0, and 2.4, respectively, for UPPP; 4.6, 3.8, and 1.6 for LAUP; and 2.4, 2.0, and 0.7 for RFTVR. Mean duration of pain with a score greater than 2 was calculated as follows: UPPP, 21.3 days; LAUP, 15.1 days; and RFTVR, 6.1 days. Mean duration of narcotic drug use for the patients who needed this medication was 10.1 days for UPPP, 7.2 days for LAUP, and 1.3 for RFTVR. Postoperative side effects (trouble with smell and taste, pharyngeal dryness, globus sensation, voice change, and pharyngonasal reflux) were more present in the UPPP and LAUP groups than in the RFTVR group. Surgeon's assessment for postoperative complications reported more wound infection, dehiscence, and posterior pillar narrowing in the UPPP and LAUP groups than in the RFTVR group. Conclusion RFTVR is a safer and less painful procedure than UPPP and LAUP for the treatment of primary snoring. Postoperative discomfort after LAUP and after UPPP appears to be very similar. [source]

Mothers' facial expressions of pain and fear and infants' pain response during immunization,

INFANT MENTAL HEALTH JOURNAL, Issue 4 2010
Rachel E. Horton
The goal of the current study was to examine the relationship between mothers' spontaneous facial expressions of pain and fear immediately preceding their infants' immunizations and infants' facial expressions of pain immediately following immunizations. Infants' observations of mothers' faces prior to immunization also were examined to explore whether these observations moderated the effect of mothers' facial expressions on infant pain. The final sample included 58 mothers and their infants. Video data were used to code maternal facial expressions, infants' observations, and infants' expressions of pain. Infants who observed their mothers' faces had mothers who expressed significantly more fear pre-needle. Furthermore, mothers' facial expressions of mild fear pre-needle were associated with lower levels of infants' pain expression post-needle. A regression analysis confirmed maternal facial expressions of mild fear pre-needle as the strongest predictor of infant pain post-needle after controlling for infants' observations of mothers' faces. Mothers' subtle facial expressions of fear may indicate a relationship history of empathic caregiving that functions to support infants' abilities to regulate distress following painful procedures. Interventions aimed at improving caregiver sensitivity to infants' emotional cues may prove beneficial to infants in pain. Future directions in research are discussed. El objetivo del presente estudio fue examinar la relación entre lasespontáneas expresiones faciales de dolor y de miedo de las madres en elmomento inmediatamente anterior a la vacunación de sus infantes, y lasexpresiones faciales de dolor de los infantes inmediatamente después dela vacunación. También se examinaron las observaciones que losinfantes hacían de las caras de las madres antes de la vacunación,con el fin de explorar si estas observaciones servían para moderar elefecto de las expresiones faciales de las madres sobre el dolor de losinfantes. El grupo muestra final incluyó 58 madres y sus infantes. Lainformación en vídeo se usó para codificar las expresionesfaciales maternales, las observaciones de los infantes, y las expresiones dedolor de los infantes. Los infantes que observaron las caras de sus madrestenían madres que expresaban significativamente más miedo antes dela aguja. Es más, las expresiones faciales de las madres de poco miedoantes de la aguja se asociaron con bajos niveles de expresiones de dolor delos infantes después de la aguja. Un análisis de Regresiónconfirmó las expresiones faciales maternales de poco miedo antes de laaguja como el factor de predicción más fuerte del dolor del infantedespués de la aguja, después del experimento de control de lasobservaciones que el infante hacía de las caras de las madres. Lasexpresiones faciales de miedo de las madres más difíciles dedetectar o analizar pudieran indicar una historia de relación con unaprestación de cuidado de más empatía, la cual funciona paraapoyar las habilidades del infante de regular la ansiedad mental despuésde procedimientos dolorosos. Las intervenciones dirigidas a mejorar lasensibilidad de quienes prestan cuidado hacia las señas emocionales delos infantes pudieran demostrar que son beneficiosas para los infantes quesienten dolor. Se discuten las futuras direcciones de la investigación. Le but de cette étude était d'examiner la relation entre lesexpressions maternelles faciales spontanées de douleur et de peurprécédant immédiatement la vaccination de leurs nourrissons etles expressions faciales des nourrissons juste après les vaccinations.Les observations faites par les nourrissons des visages de leur mèreavant la vaccination ont aussi été examinées de fa,on àexplorer si ces observations modéraient l'effet des expressions facialesdes mères sur la douleur du nourrisson. L'échantillon final a inclucinquante-trois mères et leurs bébés. Des données vidéoont été utilisées pour coder les expressions facialesmaternelles, les observations des nourrissons et les expressions de douleurdes bébés. Les bébés qui observaient le visage de leursmères avaient des mères qui exprimaient bien plus de peur "avant laseringue". De plus, les expressions faciales des mères de peurmodérée étaient liées avec des niveaux plus bas d'expressionde douleur "après seringue". Une analyse de Régression aconfirmé les expressions faciales maternelles de peur modérée"avant la seringue" comme étant le facteur de prédiction le plusfort de la douleur du bébé "après la seringue" après avoircontrollé les observations des bébés du visage de leur mere. Lesexpressions faciales subtiles de peur des mères pourraient indiquer unehistoire de relation de mode de soin empathique qui fonctionne afin desoutenir les capacités des bébés à réguler ladétresse après des procédures médicales douloureuses. Lesinterventions qui ont eu pour but d'améliorer la sensibilité du modede soin aux signes émotionnels pourraient s'avérerbénéfiques aux bébés dans la douleur. Des directions futuresde recherches sont discutées. Das Ziel der vorliegenden Studie war es, die Beziehung zwischen denmütterlichen spontanen Gesichtsausdrücke von Schmerz und Angstunmittelbar vor der Impfung ihrer Kinder und der Mimik des Schmerzes derKleinkinder unmittelbar nach Impfungen zu untersuchen. Die kindlicheBeobachtung des Gesichtsausdrucks der Mutter vor der Immunisierung wurdeebenfalls geprüft, um zu erforschen, ob die kindliche Beobachtung dieWirkung der mütterlichen Mimik bei Schmerzen ihres Kindes beeinflusst.Die endgültige Stichprobe umfasste achtundfünfzig Müttern undihre Säuglinge. Video-Daten wurden verwendet, um die mütterlicheMimik, die kindliche Beobachtung der Mutter und Äußerungen desSchmerzes der Säuglinge zu codieren. Kleinkinder die denGesichtsausdruck der Mutter beobachteten, hatten Mütter die signifikantmehr Angst vor der Nadel zum Ausdruck brachten. Darüber hinausführte eine mütterliche Mimik, die wenig Angst vor der Nadel zeigte,zu einem niedrigeren Niveau von Ausdruck von Schmerzen der nach der Impfungim Gesicht der Säuglinge. Eine Regressionsanalyse bestätigt einemütterliche Mimik der milden Angst vor der Nadel, als der stärkstePrädiktor für kindliche Schmerzen nach der Nadel, sofern dieSäuglinge den Gesichtsausdruck der Mutter beobachtet hatten. Einesubtile Mimik der Angst der Mütter deutet auf eine emphatischeMutter-Kind Beziehung hin, die darauf abzielt, die kindliche Fähigkeitder Disstressregualtion nach schmerzhaften Eingriffen zu unterstützen.Maßnahmen zur Verbesserung der Sensibilität der Bezugspersonen mitihren Säuglingen bezüglich der emotionalen Reize, könnten sichals nützlich erweisen, um Kindern in Schmerzsituationen zuunterstützen. Zukünftige Richtungen in der Forschung werdendiskutiert. [source]

Using Distraction to Reduce Reported Pain, Fear, and Behavioral Distress in Children and Adolescents: A Multisite Study

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2000
Karen L. Carlson
ISSUES AND PURPOSE. Distraction during painful procedures has been shown to be effective in previous studies, yet this simple intervention is not used routinely. This study examined the effectiveness and feasibility of distraction in reducing behavioral distress, pain, and fear during venipuncture or intravenous insertion. DESIGN AND METHODS. A two-group randomized design with 384 children in 13 children's hospitals. RESULTS. Age was a significant factor in observed behavioral distress, reports of fear, and self-reported pain. The use of a kaleidoscope, however, did not significantly reduce pain or distress during venipuncture or IV insertion. PRACTICE IMPLICATIONS. Failure of the distraction intervention to reach statistical significance in this study is puzzling, given anecdotal reports of clinical efficacy. Methodological issues may have obscured actual differences between experimental and control groups. [source]

The FLACC behavioral scale for procedural pain assessment in children aged 5,16 years

PEDIATRIC ANESTHESIA, Issue 8 2008
STEFAN NILSSON MSN RN
Summary Objectives:, To evaluate the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural pain in children aged 5,16 years. Background:, Self-reporting of pain is considered to be the primary source of information on pain intensity for older children but a validated observational tool will provide augment information to self-reports during painful procedures. Methods:, Eighty children scheduled for peripheral venous cannulation or percutaneous puncture of a venous port were included. In 40 cases two nurses simultaneously and independently assessed pain by using the FLACC scale and in 40 cases one of these nurses assessed the child. All children scored the intensity of pain by using the Coloured Analogue Scale (CAS) and distress by the Facial Affective Scale (FAS). Results:, Concurrent validity was supported by the correlation between FLACC scores and the children's self-reported CAS scores during the procedure (r = 0.59, P < 0.05). A weaker correlation was found between the FLACC scores and children's self-reported FAS (r = 0.35, P < 0.05). Construct validity was demonstrated by the increase in median FLACC score to 1 during the procedure compared with 0 before and after the procedure (P < 0.001). Interrater reliability during the procedure was supported by adequate kappa statistics for all items and for the total FLACC scores (, = 0.85, P < 0.001). Conclusions:, The findings of this study support the use of FLACC as a valid and reliable tool for assessing procedural pain in children aged 5,16 years. [source]

Propofol or propofol,alfentanil anesthesia for painful procedures in the pediatric oncology ward

PEDIATRIC ANESTHESIA, Issue 8 2004
Margareta von Heijne MD PhD
Summary Background :,For children with cancer receiving curative treatment, the pain of diagnostic and therapeutic procedures is often worse than that of the disease itself. In order to evaluate if light propofol anesthesia in the pediatric oncology ward (POW) could improve the management of procedure pain and anxiety, a questionnaire was developed. Methods :,After prolonged EMLA application, 65 propofol anesthetics were performed successfully in 28 children during lumbar puncture and/or bone marrow aspiration in the POW, with short recovery time and without major adverse events. The questionnaire was mailed to the parents of the 28 children who were included in the survey. Results :,The return of questionnaire compliance was 89% (25 of 28), 12 females and 13 males, mean age was 7 years (range 2,16). Among those who replied, the diagnoses were acute lymphatic leukemia in 21, lymphoma in two and tumor in the other two. In the questionnaire, all parents/patients reported advantages with anesthesia in the POW compared with the operating room. In the list of stated advantages, 88% marked ,familiar nurses and doctors', 84%,familiar environment', 80%,closer to own room', 68%,the child more calm', 72%,shorter waiting-time', 60%,faster recovery', 44%,shorter fasting-time' and 44%,parents more calm', as benefits. For future procedures requiring anesthesia to reduce pain, discomfort and/or anxiety, 92% of the parents/patients preferred anesthesia in the POW. Conclusions :,If anesthesia is chosen for invasive procedures, this study suggest that propofol anesthesia in the POW is preferred by parents and children. [source]

Comparison of two doses of breast milk and sucrose during neonatal heel prick

PEDIATRICS INTERNATIONAL, Issue 2 2010
Tutku Ozdogan
Abstract Background:, The aim of the present study was to test analgesic effects of double- versus single-dose breast milk and compare this effect with efficacy of double- versus single-dose sucrose in a group of healthy term newborns during heel prick blood sampling. Methods:, Healthy newborns (n= 142) were consecutively allocated to one of the six groups: group 1, single-dose breast milk; group 2, single-dose sterile water; group 3, single-dose 12.5% sucrose; group 4, two doses breast milk; group 5, two doses sterile water; and group 6, two doses 12.5% sucrose before the heel prick. The medians for crying time and the pain scores according to the neonatal facial coding system were recorded. Results:, Crying times were 117 s, 126 s, 82 s, 128 s, 117 s, and 95 s in groups 1,6, respectively (P= 0.053). The mean pain scores were 4.60, 5.82, 3.91, 4.94, 5, and 4.05 in groups 1,6, respectively (P= 0.068). There was a significant difference between the groups for mean pain scores at 1 min and 3 min. There was a significant difference between the single-dose sucrose group and single-dose sterile water group at 1 min (P= 0.002). The babies in the sucrose group were active awake, whereas the ones in the breast milk group were asleep before heel prick. Conclusion:, Two doses of sucrose solution were not superior to single-dose sucrose. Neither single nor double doses of breast milk were effective in relieving pain in neonates. Two milliliters breast milk does not reduce response to pain during minor painful procedures in term neonates even when two doses have been given. Further studies are needed. [source]

Randomized Clinical Trial of Propofol With and Without Alfentanil for Deep Procedural Sedation in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 9 2009
James R. Miner MD
Abstract Objectives:, The objectives were to compare the efficacy, occurrence of adverse events, and recovery duration of propofol with and without alfentanil for use in procedural sedation in the emergency department (ED). Methods:, This was a randomized nonblinded prospective trial of adult patients undergoing procedural sedation for painful procedures in the ED. Patients with pain before the procedure were given intravenous (IV) morphine sulfate until their pain was adequately treated at least 20 minutes before starting the procedure. Patients received 1 mg/kg propofol either with or without a supplemental dose of 10 ,g/kg alfentanil for deep procedural sedation. Doses, vital signs, nasal end-tidal CO2 (ETCO2), pulse oximetry, and bispectral electroencephalographic (EEG) analysis scores were recorded. Subclinical respiratory depression was defined as a change in ETCO2 of >10 mmHg, an oxygen saturation of <92% at any time, or an absent ETCO2 waveform at any time. Clinical events related to respiratory depression were noted during the procedure, including the addition of or increase in the flow rate of supplemental oxygen, the use of a bag-valve mask apparatus, airway repositioning, or stimulation to induce breathing. After the procedure, patients were asked if they experienced pain during the procedure or had recall of the procedure. Results:, A total of 150 patients were enrolled; 146 underwent sedation and were included in the analysis. Seventy-four patients received propofol, and 71 received propofol with alfentanil. No clinically significant complications were noted. Subclinical respiratory depression was seen in 24/74 patients in the propofol group and 30/71 patients in the propofol/alfentanil group (effect size = 9.8%, 95% CI = ,5.8% to 25.5%). Clinical signs of respiratory depression included an increase in supplemental oxygen use in 25 of the 74 propofol patients and 31 of the 71 propofol/alfentanil patients (effect size 9.9%, 95% CI = ,5.9% to 25.7%), the use of bag-valve mask apparatus in seven patients in the propofol group and 12 in the propofol/alfentanil group (effect size = 5.6%, 95% CI = ,3.5% to 18.4%), airway repositioning in 13 propofol patients and 20 propofol/alfentanil patients (effect size = 10.6%, 95% CI = ,3.0% to 24.2%), and stimulation to induce breathing in 11 propofol patients and 20 propofol/alfentanil patients (effect size = 13.3%, 95% CI = 0.1% to 26.5%). The total time of the procedure was longer for the alfentanil/propofol group (median = 11 minutes, range = 5,22 minutes) than for the propofol group (median = 9 minutes, range = 1 to 43 minutes; effect size = 1.93 minutes, 95% CI = 0.73 to 2.58, p = 0.02). Pain during the procedure was reported by 10 of the 74 patients in the propofol group and 7 of the 71 patients in the propofol/alfentanil group (effect size = 4.5%, 95% CI = ,6.8% to 14.1%). Recall of some part of the procedure was reported by 12 patients in the propofol group and 9 in the propofol/alfentanil group (effect size = 3.5%, 95% CI = ,7.9% to 15.0%). All procedures were successfully completed. Conclusions:, The use of supplemental alfentanil with propofol for procedural sedation did not result in a difference in reported pain or recall immediately after the procedure. There was an increase in the proportion of patients who required stimulation to induce respiration during the procedure in patients who received propofol with supplemental alfentanil. The addition of supplemental opioid to procedural sedation with propofol does not appear beneficial. [source]

Randomized Clinical Trial of Propofol Versus Ketamine for Procedural Sedation in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 6 2010
James R. Miner MD
Abstract Objectives:, The objective was to compare the occurrence of respiratory depression, adverse events, and recovery duration of propofol versus ketamine for use in procedural sedation in the emergency department (ED). Methods:, This was a randomized nonblinded prospective clinical trial of adult patients undergoing procedural sedation for painful procedures in the ED. Patients with pain before the procedure were treated with intravenous (IV) morphine sulfate until their pain was adequately treated at least 20 minutes before starting the procedure. Patients were randomized to receive either propofol 1 mg/kg IV followed by 0.5 mg/kg every 3 minutes as needed or ketamine 1.0 mg/kg IV followed by 0.5 mg/kg every 3 minutes as needed. Doses, vital signs, nasal end-tidal CO2 (ETCO2), and pulse oximetry were recorded. Subclinical respiratory depression was defined as a change in ETCO2 of >10 mm Hg, an oxygen saturation of <92% at any time, or an absent ETCO2 waveform at any time. Clinical interventions related to respiratory depression were noted during the procedure, including the addition of or increase in the flow rate of supplemental oxygen, the use of a bag-valve mask apparatus, airway repositioning, or stimulation to induce breathing. After the procedure, patients were asked if they experienced pain during the procedure and had recall of the procedure. Physicians were asked to describe any adverse events or the occurrence of recovery agitation. Results:, One-hundred patients were enrolled; 97 underwent sedation and were included in the analysis. Fifty patients received propofol and 47 received ketamine. Subclinical respiratory depression was seen in 20 of 50 patients in the propofol group and 30 of 47 patients in the ketamine group (p = 0.019, effect size 22.8%; 95% CI = 4.0% to 43.6%). Clinical interventions related to respiratory depression were used in 26 of 50 propofol patients and 19 of 47 ketamine patients (p = 0.253, effect size = ,13.7%; 95% CI = ,33.8% to 6.4%). The median times of the procedures were 11 minutes (range = 4 to 33 minutes) for the ketamine group versus 10 minutes (range = 5 to 33 minutes) for the propofol group (p = 0.256). The median time to return to baseline mental status after the procedure was completed was 14 minutes (range = 2 to 47 minutes) for the ketamine group and 5 minutes (range = 1 to 32 minutes) for the propofol group (p < 0.001). Pain during the procedure was reported by 3 of 50 patients in the propofol group and 1 of 47 patients in the ketamine group (effect size = ,3.9%, 95% confidence interval [CI] = ,11.9 to 4.1). Recall of some part of the procedure was reported by 4 of 50 patients in the propofol group and 6 of 47 patients in the ketamine group (effect size = 4.8%, 95% CI = ,7.6% to 17.1%). Forty-eight of 50 procedures were successful in the propofol group and 43 of 47 in the ketamine group (p = 0.357, effect size = 0.3%; 95% CI = ,7.8% to 8.4%). Recovery agitation was reported in 4 of 50 in the propofol group and 17 of 47 in the ketamine group (effect size = 28.2%, 95% CI = 12.4% to 43.9%). Conclusions:, This study detected a higher rate of subclinical respiratory depression in patients in the ketamine group than the propofol group. There was no difference in the rate of clinical interventions related to respiratory depression, pain, or recall of the procedure between the groups. Recovery agitation was seen more frequently in patients receiving ketamine than in those receiving propofol. The time to regain baseline mental status was longer in the ketamine group than the propofol group. This study suggests that the use of either ketamine or propofol is safe and effective for procedural sedation in the ED. ACADEMIC EMERGENCY MEDICINE 2010; 17:604,611 © 2010 by the Society for Academic Emergency Medicine [source]

Promoting shorter duration of ventilator treatment decreases the number of painful procedures in preterm infants

ACTA PAEDIATRICA, Issue 11 2009
A Axelin
Abstract Aim:, To investigate whether promoting shorter ventilator treatment decreases the number of painful procedures and the use of analgesics in preterm infants. Methods:, Retrospective patient chart review of all preterm infants in one Neonatal Intensive Care Unit (NICU) was carried out in 2000 (n = 240) and 2005 (n = 206). Between these cohorts, early nasal continuous positive airway pressure (nCPAP) application and early extubation policy were introduced. Results:, Fewer infants were intubated (22 vs. 32%, p = 0.03), the duration of ventilator treatment decreased (6.7 SD 11.3 vs. 9.0 SD 11.1 days, p < 0.001) and nCPAP treatment became more common (41 vs. 25%, p < 0.001) in 2005 than in 2000. Similarly, the infants' exposure to painful procedures did not decrease significantly (61.9 SD 98.5 vs. 67.1 SD 104.3 procedures, p = 0.32) but the procedures related to respiratory support were fewer (45.2 SD 79.5 vs. 68.9 SD 91.1 procedures, p < 0.001) in 2005 than in 2000. In addition, the amount of pain medication used was significantly lower in 2005 than in 2000. One day on a ventilator included more painful procedures than a day on nCPAP (11.2 95% CI: 11.0,11.5 vs. 4.2 95% CI: 4.1,4.4 procedures, p < 0.001) during both study years. Conclusion:, Early nCPAP and early extubation policies were successfully implemented in an NICU resulting in less invasive respiratory support. This was associated with fewer painful procedures and less pain medication in the preterm infants who required respiratory support. Despite this positive effect, the number of painful procedures in all preterm infants stayed at the same level. Our results provide further support for the use of nCPAP in preterm infants. [source]