American Society of Regional Anesthesia and Pain Medicine August 2017 - 24
al demonstrated improved success for IV cannulation with topical
liposomal bupivacaine. Multiple other studies have shown at least
no difference in IV cannulation success rates with the use of topical
anesthetic.18-20 Baxter et al also showed overall improved success
with lumbar punctures when using topical anesthetics, likely due to
less patient movement.21 New delivery systems feature needleless
administration of lidocaine with a drastically shorter time of onset.
In addition to the benefit of onset time, these new delivery systems
also have been shown to have better analgesic effectiveness than a
commonly used topical solution.22
"It is prudent to develop a system
to improve coping and address pain
early in a child's hospital course for
any procedure they may have."
SUCROSE/BREASTFEEDING
Another simple yet effective strategy for pain management in
neonates and infants is administration of sucrose or breastfeeding.
The administration of sucrose in concentrations of 24% or 25%
have been found to decrease pain responses in neonates.23-25
There is debate as to whether this attenuation of pain response
is from nociceptive pathways26,27 or other mechanisms,28 but
observational assessments of pain response overall have been
positive for both sucrose and breastfeeding.28 Breastfeeding or
dipping a pacifier in expressed breast milk and swaddling and
holding the infant can sustain caregiver engagement and create
a familiar, supportive approach for infant and caregiver. These
interventions, however, are limited as most positive data is in
children under 1 year of age.
This bundle of five best practice components prior to, during, and
immediately after procedures is being rolled out sequentially at
our institution. Accountability, multidisciplinary core leadership,
house-wide training with an evidence-based framework, and use of
data and champions to promote nurse and physician engagement
are key factors for this effort.29,30 An often-overlooked component
to the success of paradigm change is the input of the patients
we care for. To address this, we have developed a family advisory
council composed of current and former families who are intimately
involved in program development. Input from our family advisory
council has helped us shape best practices to tailor them to our
specific families. At the Sala Institute for Child and Family Care,
our goal is to develop a resource and provide guidance across all
hospital services regarding effective procedural pain management.
We hope to develop a systematic and comprehensive approach that
will be integrated into all procedures and ultimately lead to better,
reliable, and consistent care for our youngest patients.
24
REFERENCES
1.
Rennick JE, Johnston CC, Doughtery G, Platt R, Ritchie JA. Children's
psychological responses after critical illness and exposure to invasive
technology. J Dev Behav Pediatr. 2002;23(3):133-144.
2.
Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate
analgesia during painful procedures in children. Arch Pediatr Adolesc Med.
1998;152(2):147-149.
3.
Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative
anxiety, postoperative pain, and behavioral recovery in young children
undergoing surgery. Pediatrics. 2006;118(2):651-658.
4.
Friedrichsdorf SJ, Eull D, Weidner C. Children's comfort promise: how can
we do everything possible to prevent and treat pain in children using quality
improvement strategies? (commentary). Pediatr Pain Letter. 2016;18(3):26-30.
5.
Christensen J, Fatchett D. Promoting parental use of distraction and relaxation
in pediatric oncology patients during invasive procedures. J Pediatr Oncol Nurs.
2002;19(4):127-132.
6.
Dahlquist LM, Busby SM, Slifer KJ, et al. Distraction for children of different ages
who undergo repeated needle sticks. J Pediatr Oncol Nurs. 2002;19(1):22-34.
7.
Blount RL, Landolf-Fritsche B, Powers SW, Sturges JW. Differences between
high and low coping children and between parent and staff behaviors during
painful medical procedures. J Pediatr Psychol. 1991;16(6):795-809.
8.
Kleiber C, Craft-Rosenberg M, Harper DC. Parents as distraction coaches during
IV insertion: a randomized study. J Pain Symptom Manage. 2001;22(4):851-861.
9.
Broome ME. Helping parents support their child in pain. Pediatr Nurs.
2000;26(3):315.
10. Bauchner H, Vinci R, Bak S, Pearson C, Corwin MJ. Parents and procedures: A
randomized controlled trial. Pediatrics. 1996;98(5):861-867.
11. Haimi-Cohen Y, Amir J, Harel L, Straussberg R, Varsano Y. Parental presence
during lumbar puncture: anxiety and attitude toward the procedure. Clin Pedia.
1996;35(1):2-4.
12. Wolfram RW, Turner ED, Philput C. Effects of parental presence during young
children's venipuncture. Pediatr Emerg Care. 1997;13(5):325-328.
13. Stephens BK, Barkey ME, Hall HR. Techniques to comfort children during
stressful procedures. Accid Emerg Nurs. 1999;7(4):226-236.
14. Sparks LA, Setlik J, Luhman J. Parental holding and positioning to decrease
IV distress in young children: a randomized controlled trial. J Pediatr Nurs.
2007;22(6):440-447.
15. Kleiber C, Harper DC. Effects of distraction on children's pain and distress
during medical procedures: a meta-analysis. Nurs Res. 1999;48(1):44-49.
16. Windich-Biermeier A, Sjoberg I, Dale JC, Eshelman D, Guzzetta CE. Effects
of distraction on pain, fear, and distress during venous port access and
venipuncture in children and adolescents with cancer. J Pediatr Oncol Nurs.
2007;24(1):8-19.
17. Cramton RE, Gruchala NE. Managing procedural pain in pediatric patients. Curr
Opin Pediatr. 2012;24(4):530-538.
18. Arendts G, Stevens M, Fry M. Topical anaesthesia and intravenous cannulation
success in paediatric patients: a randomized double-blind trial. Br J Anaesth.
2008;100(4):521-524.
19. Singer AJ, Taira BR, Chisena EN, Gupta N, Chipley J. Warm lidocaine/tetracaine
patch versus placebo before pediatric intravenous cannulation: a randomized
controlled trial. Ann Emerg Med. 2008;52(1):41-47.
20. Kleiber C, Sorenson M, Whiteside K, Gronstal BA, Tannous R. Topical anesthetics
for intravenous insertion in children: a randomized equivalency study. Pediatrics.
2002;110(4):758-761.
21. Baxter AL, Fisher RG, Burke BL, Goldblatt SS, Isaacman DJ, Lawson ML. Local
anesthetic and stylet styles: factors associated with resident lumbar puncture
success. Pediatrics. 2006;117(3):876-881.
American Society of Regional Anesthesia and Pain Medicine
2017
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine August 2017
No label
American Society of Regional Anesthesia and Pain Medicine August 2017 - No label
American Society of Regional Anesthesia and Pain Medicine August 2017 - 2
American Society of Regional Anesthesia and Pain Medicine August 2017 - 3
American Society of Regional Anesthesia and Pain Medicine August 2017 - 4
American Society of Regional Anesthesia and Pain Medicine August 2017 - 5
American Society of Regional Anesthesia and Pain Medicine August 2017 - 6
American Society of Regional Anesthesia and Pain Medicine August 2017 - 7
American Society of Regional Anesthesia and Pain Medicine August 2017 - 8
American Society of Regional Anesthesia and Pain Medicine August 2017 - 9
American Society of Regional Anesthesia and Pain Medicine August 2017 - 10
American Society of Regional Anesthesia and Pain Medicine August 2017 - 11
American Society of Regional Anesthesia and Pain Medicine August 2017 - 12
American Society of Regional Anesthesia and Pain Medicine August 2017 - 13
American Society of Regional Anesthesia and Pain Medicine August 2017 - 14
American Society of Regional Anesthesia and Pain Medicine August 2017 - 15
American Society of Regional Anesthesia and Pain Medicine August 2017 - 16
American Society of Regional Anesthesia and Pain Medicine August 2017 - 17
American Society of Regional Anesthesia and Pain Medicine August 2017 - 18
American Society of Regional Anesthesia and Pain Medicine August 2017 - 19
American Society of Regional Anesthesia and Pain Medicine August 2017 - 20
American Society of Regional Anesthesia and Pain Medicine August 2017 - 21
American Society of Regional Anesthesia and Pain Medicine August 2017 - 22
American Society of Regional Anesthesia and Pain Medicine August 2017 - 23
American Society of Regional Anesthesia and Pain Medicine August 2017 - 24
American Society of Regional Anesthesia and Pain Medicine August 2017 - 25
American Society of Regional Anesthesia and Pain Medicine August 2017 - 26
American Society of Regional Anesthesia and Pain Medicine August 2017 - 27
American Society of Regional Anesthesia and Pain Medicine August 2017 - 28
American Society of Regional Anesthesia and Pain Medicine August 2017 - 29
American Society of Regional Anesthesia and Pain Medicine August 2017 - 30
American Society of Regional Anesthesia and Pain Medicine August 2017 - 31
American Society of Regional Anesthesia and Pain Medicine August 2017 - 32
American Society of Regional Anesthesia and Pain Medicine August 2017 - 33
American Society of Regional Anesthesia and Pain Medicine August 2017 - 34
American Society of Regional Anesthesia and Pain Medicine August 2017 - 35
American Society of Regional Anesthesia and Pain Medicine August 2017 - 36
http://www.brightcopy.net/allen/asra/18-04
http://www.brightcopy.net/allen/asra/18-3
http://www.brightcopy.net/allen/asra/18-2
http://www.brightcopy.net/allen/asra/18-1
http://www.brightcopy.net/allen/asra/17-4
http://www.brightcopy.net/allen/asra/17-3
http://www.brightcopy.net/allen/asra/17-2
http://www.brightcopy.net/allen/asra/17-1
http://www.brightcopy.net/allen/asra/16-4
http://www.brightcopy.net/allen/asra/16-3
http://www.brightcopy.net/allen/asra/16-2
http://www.brightcopy.net/allen/asra/16-1
http://www.brightcopy.net/allen/asra/15-4
http://www.brightcopy.net/allen/asra/15-3
https://www.nxtbook.com/allen/asra/15-2
https://www.nxtbook.com/allen/asra/15-1
https://www.nxtbookmedia.com