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Results for “Procedural Pain”

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At least 19 recordsLinked to original sources

PubMed1992

Midazolam versus fentanyl as premedication for painful procedures in children with cancer.

Premedication for painful procedures in children with cancer is not routinely used. Many medications used are only intermittently effective or require special equipment or anesthesia support. In a randomized, double-blind, crossover study, the safety and efficacy of midazolam, a short-acting benzodiazepine, were compared with the safety and efficacy of fentanyl, a short-acting narcotic analgesic. In 25 children studied, 100% of children and their parents preferred study drugs to any previous premedication. Seventy-two percent preferred midazolam to fentanyl. Preprocedural anxiety, adverse behavioral symptoms, and visual analog scales all improved and side effects were minimal. It is concluded that premedication for painful procedures should be used routinely in children with cancer. With proper monitoring, fentanyl and midazolam can be used safely in the outpatient clinic setting. Midazolam was found to be the drug of preference for the majority of patients.

Adolescent↗

PubMed1990

C.T.-guided pain procedures.

C.T.-guided stereotactic destructive pain procedures; percutaneous cordotomy, trigeminal tractotomy-nucleotomy and extralemniscal myelotomy are presented. All procedures were applied in 32 cases without any mispuncture or complication. Advantages of C.T. guidance are direct visualization of target electrode relations, measurements of spinal cord diameters at the lesion site, and demonstration of spinal cord displacement during the procedure.

Cordotomy↗

PubMed1992

Use of ethyl chloride topical anesthetic to reduce procedural pain in pediatric oncology patients.

Pediatric cancer patients often become anxious, agitated, combative, and uncooperative due to the pain or fear of pain during invasive procedures. Generally, it is not the actual administration of medicines that produces this reaction, but the fear of the needle stick itself. Increased education and implementation of coping mechanisms is often not enough to allay this fear. The tangible solution of using ethyl chloride, an anesthetic spray, before port sticks, lumbar punctures, and bone marrow aspirations, was instituted by the hematology-oncology clinic to determine if the pain, emotional trauma, and fear of cancer treatments could be reduced in oncology patients. Survey results on 60 patients and 60 parents/caretakers showed that when given the choice to use the spray or to refuse its use, 68% of the parents thought that the patient had more of a sense of control and, thus, involvement in their treatment. Seventy-eight percent of the patients reported experiencing less pain associated with procedures. Staff noted an increase in cooperation, less combativeness, and more compliance with treatment. Perceiving the child's discomfort diminished, 87% of the parents/caretakers report feeling less anxious and, therefore, more capable of being supportive to each other and their child. These results verified the staff's perceptions of the advantages of using this noninvasive anesthetic. Ethyl chloride is an easy, effective, concrete approach to reducing procedural pain in pediatric oncology patients.

Administration, Topical↗

PubMedDate not supplied

Preparation of children for painful procedures.

Preparation of the child for a painful procedure is an intervention that requires the provision of sensory-procedural information and coping skills. These coping skills, such as relaxation, distraction, or imagery can be used by the child to reduce both quantitative and qualitative aspects of the pain experience.

Adaptation, Psychological↗

PubMed1992

Ketamine. A solution to procedural pain in burned children.

Our experience has shown ketamine to be a safe and effective method of providing pain relief during specific procedures in burned children. It renders high doses of narcotics unnecessary and offers children the benefit of general anesthesia without the requirement of endotracheal intubation and a trip to the operating room. The response of parents and staff to the use of ketamine has been positive. Parents often experience feelings of guilt following injury to a child and are eager to employ methods that reduce their child's pain. So far, no parent has refused the administration of ketamine; some have even asked that it be used during subsequent procedures on their child. With adequate pre-procedure teaching, parents are prepared for the possible occurrence of emergent reactions and can assist in reorienting the child during recovery. Staff have found that the stress of doing painful procedures on children is reduced when ketamine is used. The procedures tend to be quicker and the predicament of working on a screaming, agitated child is eliminated. At the same time, nursing staff have had to get used to the nystagmic gaze of the children and accept that these patients are truly anesthetized even though they might move and talk. Despite the success we and others have had with ketamine, several questions about its use in burn patients remain unanswered. The literature does not answer such questions as: Which nursing measures reduce the incidence of emergent reactions? How many ketamine anesthetics can safely be administered to one individual? How does the frequency of administration relate to tolerance in a burn patient? Are there detrimental effects of frequent or long-term use? Clearly, an understanding of these questions is necessary to determine the safe boundaries of ketamine use in burn patients. Ketamine is not a panacea for the problem of pain in burned children. But it is one means of managing procedural pain, which is, after all, a significant clinical factor in treatment and recovery.

Burn Units↗

PubMed1992

The use of distraction and imagery with children during painful procedures.

The effectiveness of a pediatric pain management program was examined using a multiple case study design. This study examined both the children's pain experience during cancer treatment, as well as their parents' anxiety and behavioral stress. Fourteen children were videotaped while receiving lumbar punctures during an 8-12 month period. Baseline data were obtained at the first of three visits prior to the introduction of relaxation, imagery, and distraction exercises. Self-ratings of child fear and parent anxiety, videotaped observations of child and parent behavior, and child pain ratings were obtained at all three visits. The children's behavioral responses to the procedure varied considerably, but their fear scores were stable and their reports of pain decreased over time. Parents reported high-trait, low-state anxiety scores that were stable over time. They were observed to be very supportive during the procedures. Implications for further research in this area and recommendations for practice are presented.

Adolescent↗

PubMed1992

Clinicians' quick reference guide to acute pain management in infants, children, and adolescents: operative and medical procedures. Pain Management Guideline Panel. Agency for Health Care Policy and Research, US Department of Health and Human Services.

The management of pain is an important part of a health professional's role. The challenge for clinicians is to balance pain control with concern for patient safety and side effects of pain treatments. This is the second of two articles presenting the clinical highlights of the Agency for Health Care Policy and Research's Panel to develop clinical practice guidelines for pain management. This article presents the clinical highlights related to the assessment and management of pain in infants and children.

Acute Disease↗

PubMed1991