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608 IDENTIFICATION OF HIGH PREOPERATIVE ANXIETY CHILDREN FOR ANXIETY INTERVENTIONS AND POSTOPERATIVE PAIN AFTER ELECTIVE SURGERY
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
Conclusion: Low dose ketamine 0.5 mg/kg provides prolonged postoperative analgesia from 24 to 72h after surgery when added to a multimodal regimen including nonsteroidal antiinflammatory drugs. Reference(s) Dahl V, Ernoe PE, Steen T, Raeder JC, White PF. Does ketamine have preemptive effects in women undergoing abdominal hysterectomy procedures? Anesth Analg 2000; 90: 1419–22
607 USE OF SUCROSE ANALGESIA IN VERY LOW BIRTH WEIGHT NEWBORNS UNDERGOING PAINFUL MEDICAL PROCEDURES D. Dmytriiev *. Vinnitsa national medical university, Vinnitsa, Ukraine Background: Our objectives were to evaluate the effectiveness and safety of sucrose in newborns undergoing various medical procedures within 7 days of birth. Methods: We performed a double-blind, randomized controlled trial. We included 122 newborns (≥ 28 weeks gestation). Each newborn received 2 ml of a 24%-sucrose or placebo solution before all procedures. We used the Premature Infant Pain Profile to assess pain during intramuscular injection, venipuncture for the newborn screening test and the first 3 heel lances for glucose monitoring. Scores ranged from from 0 (no pain) to 18 (maximum pain). Results: We included 122 newborns. The overall mean pain score was lower among newborns who received sucrose than among those who received a placebo (mean difference [MD] −1.2, 96% confidence interval [CI] −2.0 to −0.6). We found that pain scores during intramuscular injection did not differ significantly between the sucrose and placebo groups for newborns (newborns of 1 group: MD −1.2, 95% CI −2.3 to 0.2; newborns of 2 group: MD −1.0, 94% CI −2.4 to 0.5). During venipuncture, newborns who received sucrose had lower pain scores compared with those who received a placebo (newborns of 1 group: MD −3.6, 95% CI −4.8 to −1.9; newborns of 2 group: MD −2.2, 95% CI −3.6 to −1.1). Conclusion: We found a modest reduction of pain in newborns when sucrose was used for all medical procedures performed in the first 7 days after birth. However, when each procedure was analyzed separately, we found that the effectiveness of sucrose was limited to venipuncture for the newborn screening test Reference(s) Anand KJS, Johnston CC, Oberlander T, et al. Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther 2005;27:844–76
608 IDENTIFICATION OF HIGH PREOPERATIVE ANXIETY CHILDREN FOR ANXIETY INTERVENTIONS AND POSTOPERATIVE PAIN AFTER ELECTIVE SURGERY J. Ilievska, L. Donev, V. Mitashova *. Clinic of Anesthesiology, Reanimation and Intensive Medicine, Skopje, Macedonia Background and Aims: It is acknowledged that increased anxiety before surgery in children is associated with increased postoperative pain, analgesic consumption, emergence delirium and new onset anxiety. This study is aimed to asses the influence of preoperative anxiety management on the postoperative pain in children undergoing elective surgery. Research methods: Children aged 2 to 14 years undergoing elective surgery were recruited. Children were subjected to preoperative anxiety assessment and were divided into two groups: high anxiety and low anxiety group. The two groups were randomized to be treated either with no anxiety treatment or with midazolam and other interventions (operating room tours for children and parents, induction mask and balloon introduction in holding area and parental presence at induction). The postoperative pain and analgesics consumption was measured in the first 24 hours after surgery. The incidence for emergence delirium was noted.
S177
Results: Children with low preoperative anxiety subjected to antianxiety intervention consumed comparable amount of analgesics to the low anxiety group not treated as well as the high anxiety group treated with the anti-anxiety intervention. Anxious children consumed, on average, significantly more analgesics compared with the children who were not anxious and the treated children. The highest incidence of emergence delirium was measured in the not treated high anxiety children (10% compared to 1% in the low anxiety group). Conclusions: We confirm the literature findings that children who mostly benefit from advanced preoperative anxiety treatment are the ones with preoperative high score for the preoperative anxiety risk factors. 609 PROCEDURAL PAIN IN CHILDREN M.J˜a. Mano1 , A. Fernandes2 *, P. Ribeiro1 . 1 Centro Hospitalar de Coimbra, Hospital Pedi´ atrico de Coimbra, Bloco Operat´ orio, Coimbra, Portugal; 2 Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal The worst experiences reported by hospitalized children are painful procedures. When these are repeated often, anxiety and fear add to pain. As part of a multicentre study, the aim of this pilot-study was to identify the type of painful procedures in hospitalized children, the level of pain and anxiety before and during the procedure and the interventions used to reduce pain. In a paediatric hospital, during one week, nurses were asked to record as many painful procedures performed to in-patients as possible. Pain was rated by verbal children on a self-report scale. Pain in non-verbal children and anxiety were rated by nurses using a behavioural scale and a five-point qualitative scale, respectively. Twenty-three procedures were recorded in 89 children aged 0–23. Pain during the procedure was severe/very severe in more than one-third of the children. The most common procedure was venepuncture (n = 45) followed by wound care (n = 11). Although all children had EMLA® cream before venepuncture, moderate/severe pain was reported by 17 children. Other types of analgesia occurred in only 3 children. Two of these reported severe/very severe pain. Except for venepuncture, none of the existing protocols for pain relief in specific procedures were used. Nurse initiated cognitivebehavioural interventions were used in 56 children. In this small sample, procedures recorded may not be representative of the number and type of procedures performed but it is clear that children continue to endure unnecessary pain. A larger study in this setting with a bigger sample of children and procedures is warranted. Multicenter study sponsored by AirLiquide Medical, SA 610 THE IMPACT OF PAIN ON ATTENTION PROCESSES IN SECOND GRADERS OF PRIMARY SCHOOL G.G. Ostkirchen *, M. Howoritsch, H.C. Diener. Medical Faculty of the University Duisburg-Essen Clinic of Neurology, Essen, Germany The influence of pain on attention performances is discussed controversely for adults in scientific literature; for children relevant data are rare. This study investigates the possible impairments of attention functions in second graders. Children with recurrent pain experiences (caused by juvenile rheumatic arthritis [OP] or by functional primary headache or abdominal pain [FP]) are compared to painfree children (NP). Each of these three groups consists of 35 children (16 boys, 19 girls) matched by gender and age (mean age 8.5 years). The attention processes are assessed by the subtests “Alertness (A)”, “selective attention (SA)” and “shift of attention (RW)” of the TAP (Zimmermann & Fimm, 2002). Statistical analyses are conducted by SPSS with an alpha <0.05 (beta = 0.12, power = 0.88, 5 = 0.3, N = 105). Mean reaction times differ significantly between pain groups: subtests “A” [F(2.98) = 3.283; p = 0.042; posthoc: NP = 322 ms,
Conclusion: Low dose ketamine 0.5 mg/kg provides prolonged postoperative analgesia from 24 to 72h after surgery when added to a multimodal regimen including nonsteroidal antiinflammatory drugs. Reference(s) Dahl V, Ernoe PE, Steen T, Raeder JC, White PF. Does ketamine have preemptive effects in women undergoing abdominal hysterectomy procedures? Anesth Analg 2000; 90: 1419–22
607 USE OF SUCROSE ANALGESIA IN VERY LOW BIRTH WEIGHT NEWBORNS UNDERGOING PAINFUL MEDICAL PROCEDURES D. Dmytriiev *. Vinnitsa national medical university, Vinnitsa, Ukraine Background: Our objectives were to evaluate the effectiveness and safety of sucrose in newborns undergoing various medical procedures within 7 days of birth. Methods: We performed a double-blind, randomized controlled trial. We included 122 newborns (≥ 28 weeks gestation). Each newborn received 2 ml of a 24%-sucrose or placebo solution before all procedures. We used the Premature Infant Pain Profile to assess pain during intramuscular injection, venipuncture for the newborn screening test and the first 3 heel lances for glucose monitoring. Scores ranged from from 0 (no pain) to 18 (maximum pain). Results: We included 122 newborns. The overall mean pain score was lower among newborns who received sucrose than among those who received a placebo (mean difference [MD] −1.2, 96% confidence interval [CI] −2.0 to −0.6). We found that pain scores during intramuscular injection did not differ significantly between the sucrose and placebo groups for newborns (newborns of 1 group: MD −1.2, 95% CI −2.3 to 0.2; newborns of 2 group: MD −1.0, 94% CI −2.4 to 0.5). During venipuncture, newborns who received sucrose had lower pain scores compared with those who received a placebo (newborns of 1 group: MD −3.6, 95% CI −4.8 to −1.9; newborns of 2 group: MD −2.2, 95% CI −3.6 to −1.1). Conclusion: We found a modest reduction of pain in newborns when sucrose was used for all medical procedures performed in the first 7 days after birth. However, when each procedure was analyzed separately, we found that the effectiveness of sucrose was limited to venipuncture for the newborn screening test Reference(s) Anand KJS, Johnston CC, Oberlander T, et al. Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther 2005;27:844–76
608 IDENTIFICATION OF HIGH PREOPERATIVE ANXIETY CHILDREN FOR ANXIETY INTERVENTIONS AND POSTOPERATIVE PAIN AFTER ELECTIVE SURGERY J. Ilievska, L. Donev, V. Mitashova *. Clinic of Anesthesiology, Reanimation and Intensive Medicine, Skopje, Macedonia Background and Aims: It is acknowledged that increased anxiety before surgery in children is associated with increased postoperative pain, analgesic consumption, emergence delirium and new onset anxiety. This study is aimed to asses the influence of preoperative anxiety management on the postoperative pain in children undergoing elective surgery. Research methods: Children aged 2 to 14 years undergoing elective surgery were recruited. Children were subjected to preoperative anxiety assessment and were divided into two groups: high anxiety and low anxiety group. The two groups were randomized to be treated either with no anxiety treatment or with midazolam and other interventions (operating room tours for children and parents, induction mask and balloon introduction in holding area and parental presence at induction). The postoperative pain and analgesics consumption was measured in the first 24 hours after surgery. The incidence for emergence delirium was noted.
S177
Results: Children with low preoperative anxiety subjected to antianxiety intervention consumed comparable amount of analgesics to the low anxiety group not treated as well as the high anxiety group treated with the anti-anxiety intervention. Anxious children consumed, on average, significantly more analgesics compared with the children who were not anxious and the treated children. The highest incidence of emergence delirium was measured in the not treated high anxiety children (10% compared to 1% in the low anxiety group). Conclusions: We confirm the literature findings that children who mostly benefit from advanced preoperative anxiety treatment are the ones with preoperative high score for the preoperative anxiety risk factors. 609 PROCEDURAL PAIN IN CHILDREN M.J˜a. Mano1 , A. Fernandes2 *, P. Ribeiro1 . 1 Centro Hospitalar de Coimbra, Hospital Pedi´ atrico de Coimbra, Bloco Operat´ orio, Coimbra, Portugal; 2 Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal The worst experiences reported by hospitalized children are painful procedures. When these are repeated often, anxiety and fear add to pain. As part of a multicentre study, the aim of this pilot-study was to identify the type of painful procedures in hospitalized children, the level of pain and anxiety before and during the procedure and the interventions used to reduce pain. In a paediatric hospital, during one week, nurses were asked to record as many painful procedures performed to in-patients as possible. Pain was rated by verbal children on a self-report scale. Pain in non-verbal children and anxiety were rated by nurses using a behavioural scale and a five-point qualitative scale, respectively. Twenty-three procedures were recorded in 89 children aged 0–23. Pain during the procedure was severe/very severe in more than one-third of the children. The most common procedure was venepuncture (n = 45) followed by wound care (n = 11). Although all children had EMLA® cream before venepuncture, moderate/severe pain was reported by 17 children. Other types of analgesia occurred in only 3 children. Two of these reported severe/very severe pain. Except for venepuncture, none of the existing protocols for pain relief in specific procedures were used. Nurse initiated cognitivebehavioural interventions were used in 56 children. In this small sample, procedures recorded may not be representative of the number and type of procedures performed but it is clear that children continue to endure unnecessary pain. A larger study in this setting with a bigger sample of children and procedures is warranted. Multicenter study sponsored by AirLiquide Medical, SA 610 THE IMPACT OF PAIN ON ATTENTION PROCESSES IN SECOND GRADERS OF PRIMARY SCHOOL G.G. Ostkirchen *, M. Howoritsch, H.C. Diener. Medical Faculty of the University Duisburg-Essen Clinic of Neurology, Essen, Germany The influence of pain on attention performances is discussed controversely for adults in scientific literature; for children relevant data are rare. This study investigates the possible impairments of attention functions in second graders. Children with recurrent pain experiences (caused by juvenile rheumatic arthritis [OP] or by functional primary headache or abdominal pain [FP]) are compared to painfree children (NP). Each of these three groups consists of 35 children (16 boys, 19 girls) matched by gender and age (mean age 8.5 years). The attention processes are assessed by the subtests “Alertness (A)”, “selective attention (SA)” and “shift of attention (RW)” of the TAP (Zimmermann & Fimm, 2002). Statistical analyses are conducted by SPSS with an alpha <0.05 (beta = 0.12, power = 0.88, 5 = 0.3, N = 105). Mean reaction times differ significantly between pain groups: subtests “A” [F(2.98) = 3.283; p = 0.042; posthoc: NP = 322 ms,