149 Pain Management Practices in the Emergency Department: 10 Years of Experience in an Academic Center

Introduction: Needle-related procedures are considered the most important source of pain and distress in children in hospital settings. Time constraints, heavy workload, busy and noisy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices. The objective was to determine if a device combining cold and vibration (Buzzy) is non-inferior (no worse) to a topical anesthetic (Maxilene) for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to the Buzzy or Maxilene group. The primary outcome was the mean difference in pain intensity during the procedure, as measured with the CAS (0-10). Secondary outcomes were procedural distress, success of the procedure at first-attempt and satisfaction of parents. Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI -0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602). Parents of both groups were very satisfied with both interventions (Buzzy = 7.8 ±2.66; Maxilene = 8.1 ±2.4), but there was no significant difference between groups (p = .236). Conclusion: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require time, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention.

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Self-perceived pain characteristics, pain management practices and patient satisfaction in the emergency department of District General Hospital, Kalutara

Sri Lanka Journal of Medicine ◽

10.4038/sljm.v30i1.204 ◽

2021 ◽

Vol 30 (1) ◽

pp. 25

Author(s):

P. D. Kawiratne ◽

C. M. A. D. Chandrasekara

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Pain Management ◽

General Hospital ◽

Management Practices ◽

District General Hospital ◽

Perceived Pain ◽

Pain Characteristics

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11 Identifying Race and Sex-Based Discrepancies in Pain Management Practices in the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2020.09.021 ◽

2020 ◽

Vol 76 (4) ◽

pp. S5

Author(s):

B. Kincade ◽

M. Melaku ◽

J. Krizo ◽

C. Mangira ◽

A. Burns ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Management Practices

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Acute Care: Pain Management

10.2310/pm.4347 ◽

2019 ◽

Author(s):

Claudia Ranniger

Keyword(s):

Emergency Department ◽

Pain Management ◽

Regional Anesthesia ◽

Acute Pain ◽

Management Practices ◽

Rating Scale ◽

Hand Position ◽

Ultrasound Guided ◽

The Face ◽

Ed Visits

Pain is a chief complaint in more than 50% of emergency department (ED) visits. Injury accounts for approximately one-third of presentations associated with pain; other common diagnoses include neck and back pain, minor infections, abdominal pain, and headache. In the ED, pain is underdiagnosed and undertreated, and existing pain management practices in the ED are inconsistent. Inadequate pain management is common, and pain remains unchanged or worsens during the ED visit for more than 40% of patients. Patient satisfaction improves when expectations for pain control are met. This review covers the pathophysiology of pain and the practice of pain management. Figures show the approach to pain management in the ED, an example of a numerical and visual analog scale pain rating scale, field block of the pinna, ultrasound probe and hand position for ultrasound-guided regional anesthesia, regional anesthesia of the face, innervation of the hand and fingers, regional anesthesia of the median, radial and ulnar nerves, innervation of the foot, ultrasound-guided regional anesthesia of the posterior tibialis nerve, regional anesthesia of the sural nerve, and method of regional anesthesia of the dorsal foot. This review contains 13 figures, 15 tables, and 71 references. Key words: Acute pain, Pain management, Oligoanalgesia, Pain assessment, Inadequate pain management, Acute pain management, Pain management in the emergency department, Pain in the ED, Pain presentation

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Acute Care: Pain Management

10.2310/em.4347 ◽

2020 ◽

Author(s):

Claudia Ranniger

Keyword(s):

Emergency Department ◽

Pain Management ◽

Regional Anesthesia ◽

Acute Pain ◽

Management Practices ◽

Rating Scale ◽

Hand Position ◽

Ultrasound Guided ◽

The Face ◽

Ed Visits

Pain is a chief complaint in more than 50% of emergency department (ED) visits. Injury accounts for approximately one-third of presentations associated with pain; other common diagnoses include neck and back pain, minor infections, abdominal pain, and headache. In the ED, pain is underdiagnosed and undertreated, and existing pain management practices in the ED are inconsistent. Inadequate pain management is common, and pain remains unchanged or worsens during the ED visit for more than 40% of patients. Patient satisfaction improves when expectations for pain control are met. This review covers the pathophysiology of pain and the practice of pain management. Figures show the approach to pain management in the ED, an example of a numerical and visual analog scale pain rating scale, field block of the pinna, ultrasound probe and hand position for ultrasound-guided regional anesthesia, regional anesthesia of the face, innervation of the hand and fingers, regional anesthesia of the median, radial and ulnar nerves, innervation of the foot, ultrasound-guided regional anesthesia of the posterior tibialis nerve, regional anesthesia of the sural nerve, and method of regional anesthesia of the dorsal foot. This review contains 13 figures, 16 tables, and 72 references. Key words: Acute pain, Pain management, Oligoanalgesia, Pain assessment, Inadequate pain management, Acute pain management, Pain management in the emergency department, Pain in the ED, Pain presentation

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