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Assessing and managing pain
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Lindsey Pollard, Harriet Barker
Pain assessment has also been identified as a major issue with people with learning disabilities as they can struggle to communicate their pain effectively. A study by Stone-Pearn (2002), which continues to be cited by various authors, including Beacroft and Dodd (2010), suggests that people with learning difficulties tend to be nonspecific about the duration of their pain and use external body locations and unusual terms in describing it. There are a number of pain assessment tools available including the FLACC Scale (1997), which was developed for pain assessment with children, and which has been found to be reliable and valid for children with severe learning difficulties. An example of the FLACC pain scale can be found at on the Health.gov.au website.
With Plush Toys, It Hurts Less
Published in Lawrence C. Rubin, Handbook of Medical Play Therapy and Child Life, 2017
Ana M. Ullán, Manuel H. Belver
To assess the children’s pain in both groups, we used the FLACC scale (Merkel, Voepel-Lewis, Shayevitz, & Malviya, 1997), which stands for face, legs, activity, cry, and consolability. This observational scale was developed as a simple and consistent tool to identify, describe, and assess small children’s (between 2 months and 7 years) pain in clinical settings. It includes five categories of behavior (face, legs, activity, crying, and consolability). Each category is scored on a scale ranging from 0 to 2 points and the total result of the scale ranges between 0 and 10 points. The scale has shown high inter-rater reliability. Its validity was initially proved by the significant decrease observed in the scale scores when analgesics were administered to the children (Merkel et al., 1997). Its validity was also supported by the correlation of its scores with other measures of pain, specifically the scores of the Objective Pain Scale (OPS) and the global scores of pain performed by the nursing staff (Merkel et al., 1997). The FLACC scale is recommended as the first choice to assess postsurgical pain in the hospital as an outcome measure in clinical trials (von Baeyer & Spagrud, 2007).
Management problems
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Pain assessment in special circumstances such as children and cognitively impaired patients may need pictorial scales and behavioural scales (e.g. FLACC scale, Abbey pain scale). The scale used should be easy to use and one that the patient understands and provides consistent responses.
Parental active participation during induction of general anesthesia to decrease children anxiety and pain
Published in Egyptian Journal of Anaesthesia, 2022
Tarek I Ismail, Rabab S. S. Mahrous
However, in this review, the included studies didn’t evaluate prepared parents to be present in the operating room. Eijler et al. [49] also found that distraction therapy for children in day case surgery through provision of virtual reality exposure had no valuable effect on pain and anxiety. In our trial, relatively small proportion of our patients in both groups experienced substantial levels of pain and needed less rescue analgesia. These results are because of adequate pain management. These results are in line with low incidence of emergence delirium in both groups. As it is well known that it is difficult to differentiate between pain from emergence delirium, we included valid scale that may also reflect pain [50]. FLACC scale includes consolability items [15]. It is concluded that low incidence of emergence delirium in both groups could be related to the efficacy of the observer. The well-trained observer in our trial was adequately able to differentiate between agitation due to delirium from other causes such as pain or anxiety [51].
Effect of peribulbar block on emergence agitation in children undergoing strabismus surgery under desflurane anaesthesia
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Jeetinder Kaur Makkar, Aswini Kuberan, Preet Mohinder Singh, Arun Magadi Gopinath, Kajal Jain, Jaspreet Singh, Narinder Pal Singh
The incidence of untoward airway events after removal of the LMA such as breath holding (holding breath for 20 seconds or more after the removal of LMA) severe coughing or strain (severe coughs defined as four or more coughs and SpO2 < 95%) were recorded. Children were then transferred to the PACU after demonstrating a regular respiratory pattern, facial grimacing and purposeful movement. Upon arrival in the PACU, all children were received by one of their parents. Emergence time was defined as the time to first response to a simple verbal command after removal of the LMA. Emergence agitation was assessed continuously from removal of LMA to one hour after surgery and was recorded at 5, 10, 15, 20, 25, 30, 45 and 60 minutes using the Paediatric Anaesthesia Emergence Delirium (PAED) scale.12 The PAED scale contains five items (eye contact, purposefulness of actions, awareness of surroundings, restlessness and consolability), each scored on a 0–4 scale, to a maximum of 20 points. A perfectly calm child scores 0 and extreme agitation corresponds to 20 points. The peak EA score was recorded. Agitation scores < 10 were interpreted as an absence of agitation, scores ≥ 10 were regarded as presence of agitation, and scores ≥ 15 were regarded as severe agitation. PAED scoring was done in all cases by a single blinded anaesthesiologist. Pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale score. For patients with a total PAED score of > 10 or a FLACC scale > 3 in the PACU, the first measure was to facilitate parental contact. Intravenous fentanyl 1 µgm/kg was administered to children with a FLACC score ≥ 3 and these patients were then removed from analysis for agitation. Time to rescue analgesia (time from receival of a child in PACU to administration of rescue dose of fentanyl) was recorded. Propofol 1 mg/kg was given intravenously to treat agitation in a pain-free child when parental contact failed to console a child with an agitation score of more than 10 and was repeated after 10 minutes if needed. Postoperative vomiting was assessed using numerical rank score for emesis. A pain-free, calm child with a modified Aldrete score ≥ 9 was considered fit for discharge.