Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures

Question 1

What is reported by children to be the worst pain that they experience in hospital?

Answer 1

needle related

Question 2

What is the 3P approach for pain?

Answer 2

Pharmacological
Psychological
Physical

Question 3

What age do children benefit from preparation psychological strategies for pain?

Answer 3

> 4 yr

Note: distraction strategies is the most widely studied cognitive strategy for needle-related procedural pain and distress in kids >= 2 yrs

Question 4

What are side effects of EMLA (lidocaine-prilocaine)?

Answer 4

Methemoglobinemia (increased if <1 yr old)
vasoconstriction
Contraindicated in G6PD, heart block, severe hepatic disorder

Question 5

What are side effects of Maxilene (liposomal lidocaine)?

Answer 5

Methemoglobinemia

Question 6

What is a contraindication for Ametop (amethocaine tetracaine)

Answer 6

Allergy (PABA and sulfonamides)

Question 7

What is a contraindication for Vapocoolant spray?

Answer 7

< 3 years of age

Question 8

What are contraindications for LET (lidocaine/epi/tetracaine)?

Answer 8

pt < 3 mo old, on mucosal surfaces and in large, deep or contaminated wounds

Used for minor lacerations

Question 9

What can you do to help with injection pain from local infiltration with lidocaine or nerve block?

Answer 9

add bicarbonate in 1:10 volume ratio
warm injection solution to body temp
inject slowly with small gauge needle

Question 10

What do you do for pain control related to radiographs for fractures/dislocation?

Answer 10

Ibuprofen superior to acetaminophen
- ibuprofen equivalent to oral morphine!!

IN fentanyl for mod-severe pain