scholarly journals LO33: External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomized controlled non-inferiority trial

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S19
Author(s):  
A. Ballard ◽  
C. Khadra ◽  
S. Adler ◽  
E. Parent ◽  
E. D. Trottier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Management Practices ◽  
Mean Difference ◽  
Procedural Pain ◽  
Topical Anesthetic ◽  
Promising Alternative ◽  
Require Time ◽  
Randomized Controlled ◽  
Significant Difference

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.

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

2011 ◽  
Vol 58 (4) ◽  
pp. S227 ◽  
Author(s):  
O. Cinar ◽  
J. Blankenship ◽  
D. Fosnocht ◽  
J. White ◽  
L. Rogers ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Management Practices ◽  
Years Of Experience ◽  
Academic Center

scholarly journals 100 External Cold and Vibration for Pain Management of Children Undergoing Needle-Related Procedures in the Emergency Department: A Randomized Controlled Non-Inferiority Trial

2019 ◽  
Vol 24 (Supplement_2) ◽  
pp. e38-e38
Author(s):  
Ariane Ballard ◽  
Christelle Khadra ◽  
Samara Adler ◽  
Emilie Parent ◽  
Evelyne D Trottier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Randomized Controlled

scholarly journals A randomized trial of iPad distraction to reduce children’s pain and distress during intravenous cannulation in the paediatric emergency department

2020 ◽  
Author(s):  
Samina Ali ◽  
Keon Ma ◽  
Nadia Dow ◽  
Ben Vandermeer ◽  
Shannon Scott ◽  
...  
Keyword(s):  
Emergency Department ◽  
Standard Care ◽  
Controlled Trial ◽  
Pain Scale ◽  
Emergency Department Visits ◽  
Child Life ◽  
Topical Anesthetic ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Significant Difference

Abstract Objectives We compared the addition of iPad distraction to standard care, versus standard care alone, to manage the pain and distress of intravenous (IV) cannulation. Methods Eighty-five children aged 6 to 11 years requiring IV cannulation (without child life services present) were recruited for a randomized controlled trial from a paediatric emergency department. Primary outcomes were self-reported pain (Faces Pain Scale-Revised [FPS-R]) and distress (Observational Scale of Behavioral Distress-Revised [OSBD-R]), analyzed with two-sample t-tests, Mann–Whitney U-tests, and regression analysis. Results Forty-two children received iPad distraction and 43 standard care; forty (95%) and 35 (81%) received topical anesthesia, respectively (P=0.09). There was no significant difference in procedural pain using an iPad (median [interquartile range]: 2.0 [0.0, 6.0]) in addition to standard care (2.0 [2.0, 6.0]) (P=0.35). There was no significant change from baseline behavioural distress using an iPad (mean ± SD: 0.53 ± 1.19) in addition to standard care (0.43 ± 1.56) (P=0.44). Less total behavioural distress was associated with having prior emergency department visits (odds ratio [95% confidence interval]: −1.90 [−3.37, −0.43]) or being discharged home (−1.78 [−3.04, −0.52]); prior hospitalization was associated with greater distress (1.29 [0.09, 2.49]). Significantly more parents wished to have the same approach in the future in the iPad arm (41 of 41, 100%) compared to standard care (36 of 42, 86%) (P=0.03). Conclusions iPad distraction during IV cannulation in school-aged children was not associated with less pain or distress than standard care alone. The effects of iPad distraction may have been blunted by topical anesthetic cream usage. Clinical trials registration ClinicalTrials.gov: NCT02326623.

scholarly journals Massage therapy for paediatric procedural pain: A rapid review

2019 ◽  
Author(s):  
Kylie Bernstein ◽  
Mohammad Karkhaneh ◽  
Liliane Zorzela ◽  
Hsing Jou ◽  
Sunita Vohra
Keyword(s):  
Pain Management ◽  
Standard Care ◽  
Complementary Therapies ◽  
Massage Therapy ◽  
Risk Of Bias ◽  
Rapid Review ◽  
Secondary Outcome ◽  
Procedural Pain ◽  
Randomized Controlled ◽  
Pain Scales

Abstract Background Pain is a common paediatric problem, and procedural pain, in particular, can be difficult to manage. Complementary therapies are often sought for pain management, including massage therapy (MT). We assessed the evidence for use of MT for acute procedural pain management in children. Methods We searched five main databases for (i) primary studies in English, (ii) included children 0 to 18 years of age, (iii) compared MT for procedural pain management to standard care alone or placebo, and (iv) measured pain as the primary or secondary outcome. The data were extracted by one author and verified by a second author. Randomized controlled trials were evaluated using the Cochrane Risk of Bias tool. Results Eleven paediatric trials of procedural pain in neonatal, burn, and oncology populations, a total of 771 participants, were identified. Eight reported statistically significant reductions in pain after MT compared to standard care. Pain was measured using validated pain scales, or physiologic indicators. The studies were heterogeneous in population, techniques, and outcome measures used. No adverse events associated with MT were identified. Conclusion MT may be an effective nonpharmacologic adjunct for management of procedural pain in children.

scholarly journals Randomized controlled trial of emergency department initiated smoking cessation counselling and referral to a community counselling service

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 556-564 ◽  
Author(s):  
Ka Wai Cheung ◽  
Ian WH. Wong ◽  
Warren Fingrut ◽  
Amy Po Yu Tsai ◽  
Sally R. Ke ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Smoking Cessation ◽  
Controlled Trial ◽  
Intervention Group ◽  
Counselling Service ◽  
Randomized Controlled ◽  
Smoking Cessation Counselling ◽  
Significant Difference ◽  
Community Counselling

AbstractObjectiveWorldwide, tobacco smoke is still the leading cause of preventable morbidity and mortality. Many smokers develop chronic smoking-related conditions that require emergency department (ED) visits. However, best practices for ED smoking cessation counselling are still unclear.MethodsA randomized controlled trial was conducted to determine whether an “ask, advise, and refer” approach increases 12-month, 30-day quit rates in the stable adult ED smoking population compared to usual care. Patients in the intervention group were referred to a community counselling service that offers a quitline, a text-based program, and a Web-based program. Longitudinal intention-to-treat analyses were performed.ResultsFrom November 2011 to March 2013, 1,295 patients were enrolled from one academic tertiary care ED. Six hundred thirty-five were allocated to usual care, and 660 were allocated to intervention. Follow-up data were available for 70% of all patients at 12 months. There was no statistically significant difference in 12-month, 30-day quit rates between the two groups. However, there was a trend towards higher 7-day quit attempts, 7-day quit rates, and 30-day quit rates at 3, 6, and 12 months in the intervention group.ConclusionIn this study, there was a trend towards increased smoking cessation following referral to a community counselling service. There was no statistically significant difference. However, if ED smoking cessation efforts were to provide even a small positive effect, such an intervention may have a significant public health impact given the extensive reach of emergency physicians.

Nonpharmacologic Management of Procedural Pain in Pediatric Burn Patients: A Systematic Review of Randomized Controlled Trials

2021 ◽  
Author(s):  
Matthew Gillum ◽  
Samantha Huang ◽  
Yuki Kuromaru ◽  
Justin Dang ◽  
Haig A Yenikomshian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Randomized Controlled Trials ◽  
Burn Injury ◽  
Pediatric Population ◽  
Procedural Pain ◽  
Controlled Trials ◽  
Burn Patients ◽  
Randomized Controlled ◽  
Effective Adjunct

Abstract Pain following burn injury is associated with long-term health consequences in the pediatric population. Literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct for these patients. This study aims to summarize randomized controlled trials on nonpharmacologic procedural pain management in pediatric burn patients. A systematic review was conducted on nonpharmacologic procedural pain management techniques used in the pediatric burn population. Fifteen studies were included and involved virtual reality, distraction devices, child life therapy, directed play, digital tablet games, cartoons, hypnosis, and music therapy. Treatment was effective in 8 out of 15 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 19.7% and post procedure pain by 20.1%. This study demonstrates nonpharmacologic therapy can be an effective adjunct in pediatric procedural burn pain management, however further studies are needed to develop standardized algorithms to integrate nonpharmacologic treatments with pharmacologic therapies.

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