The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years

Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: The FAN observational study

INTRODUCTION

Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N₂O) allow for short recovery time and obviates painful and time-consuming IV access insertions.

METHODS

We performed a bicentric, prospective, observational cohort study. Patients aged 4-18years were included if they received combined PSA with IN fentanyl and N₂O for the reduction of mildly/moderately displaced fracture or of dislocation. Facial Pain Scale Revised (FPS-R) and Face, Leg, Activity, Cry, Consolability (FLACC) scores were used to evaluate pain and anxiety before, during and after procedure. University of Michigan Sedation Score (UMSS), adverse events, detailed side effects and satisfaction of patients, parents and medical staff were recorded at discharge. A follow up telephone call was made after 24-72h.

RESULTS

90 patients were included. There was no difference in FPS-R during the procedure (median score 2 versus 2), but the FLACC score was significantly higher as compared to before (median score 4 versus 0, Δ 2, 95% CI 0, 2). Median UMSS was 1 (95% CI 1, 2). We recorded no serious adverse events. Rate of vomiting was 12% (11/84). Satisfaction was high among participants responding to this question 85/88 (97%) of parents, 74/83 (89%) of patients and 82/85 (96%) of physicians would want the same sedation again.

CONCLUSION

PSA with IN fentanyl and N₂O is effective and safe for the reduction of mildly/moderately displaced fracture or dislocation, and has a high satisfaction rate.

The use of the FLACC pain scale in pediatric patients undergoing adenotonsillectomy

OBJECTIVES

1) Determine the usage rate of opioid pain medication after adenotonsillectomy (T&A). 2) Review the use of the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale for T&A patients 3) Determine the rate of postoperative physician contacts for pain related complaints.

METHODS

A retrospective case series review was performed on 125 pediatric patients undergoing T&A and subsequent 23-hour postoperative observation at an academic tertiary care center from June-August of 2015. Postoperative pain scores using the FLACC pain scale, the utilization of opioid pain medications, and the number of postoperative contacts for pain were recorded.

RESULTS

Average age of patients was 5.7 years and 50% were female. 90% of T&A's were performed for adenotonsillar hypertrophy. The post-tonsillectomy hemorrhage rate was 4%. 70 (56%) patients required postoperative opioid pain medication, with (30) 43% of these patients requiring more than one dose. The mean number of opioid doses was 1.64 ± 0.9 and was not related to age, weight or gender. FLACC scores were highly associated (spearman correlation 0.77) with the amount of opioid medication given. Mean FLACC scores decreased over time after T&A. 20% of patients contacted a physician for unsatisfactory pain control postoperatively with 6% requiring emergency department visits and 14% contacting the office via phone call.

CONCLUSIONS

A significant portion of pediatric patients undergoing T&A require postoperative opioids for pain control. The FLACC scale is a valuable way of quantifying post-operative T&A pain in pediatric patients. Despite routine pain management postoperatively, a significant proportion of patients require contact with a physician postoperatively for pain management.

Comparison of a New Auto-controlled Injection System with Traditional Syringe for Mandibular Infiltrations in Children: A Randomized Clinical Trial

Background:

Pain in the dental operatory can have a profound effect on the behavior of children.

Aim:

The aim of this study is to evaluate the pain perception while administering local infiltration, in children undergoing dental extractions, using a new auto-controlled injection system.

Materials and Methods:

Children in the age range of 6–10 years with teeth indicated for extraction were recruited and allocated to either Group I, computer-controlled injection system (auto system with special cartridge and compatible disposable 30-gauge, 10 mm needles), or Group II, traditional system (30-gauge, 10 mm needle and disposable traditional syringe). Local infiltration was administered and extraction performed after 3 min. The time of administration (TOA) of infiltrate was noted whereas anxiety and pain in both groups were assessed using the Modified Child Dental Anxiety Faces Scale simplified (MCDAS_(f)), pulse rate, Faces Pain Scale-Revised (FPS-R), and Face, Legs, Activity, Cry, Consolability (FLACC) Scale.

Results:

The TOA was high in computer group, compared to the traditional system (P < 0.001***); however, anxiety and pain were significantly less in computer group as reported in MCDAS_(f), pulse rate, FPS-R, and FLACC (P < 0.001***).

Conclusions:

Computer system created a positive and comfortable experience for the child, as well as the practitioner. The possibility of using buccal infiltration instead of inferior alveolar nerve block in children below 10 years was also demonstrated.

Effect of N-Methyl-D-Aspartate Receptor Antagonist Dextromethorphan on Opioid Analgesia in Pediatric Intensive Care Unit

Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT). Setting. Pediatric multidisciplinary ICU in tertiary care center. Patients. Thirty-six pediatric patients 2–14 years of age in a multidisciplinary PICU requiring analgesia were randomized into dextromethorphan and placebo. The subjects in both groups showed similarity in most of the characteristics. Interventions. Subjects while receiving fentanyl for pain control received dextromethorphan or placebo through nasogastric/orogastric tubes for 96 hours. Pain was assessed using FLACC and faces scales. Measurements and Main Results. This study found no statistical significant difference in fentanyl requirements between subjects receiving dextromethorphan and those receiving placebo (p = 0.127). Conclusions. Dextromethorphan has no effect on opioid requirement for control of acute pain in children admitted with acute critical care illness in PICU. The registration number for this trial is NCT01553435.

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

Comparison of caudal tramadol versus caudal fentanyl with bupivacaine for prolongation of postoperative analgesia in pediatric patients

Background and Aims:

Caudal block is a common technique for pediatric analgesia for infraumblical surgeries. Because of the short duration of analgesia with bupivacaine alone various additive have been used to prolong the action of bupivacaine. The present study was aimed to evaluate the analgesic effect of tramadol or fentanyl added to bupivacaine for infraumblical surgeries in pediatric patients.

Materials and Methods:

We conducted a prospective, randomized, single-blind controlled trial. After written informed consent from parents, 100 patients belonging to American Society of Anesthesiologist physical status I-II, in the age group of 1-12 years, of either sex undergoing infraumblical surgery under general anesthesia were divided into two groups. Group BT received 1 ml/kg of 0.25% bupivacaine with tramadol 2 mg/kg in normal saline and Group BF received 1 ml/kg of 0.25% bupivacaine with fentanyl 2 μg/kg in normal saline with maximum volume of 12 ml in both groups. All patients were assessed intraoperatively for hemodynamic changes, the requirement of sevoflurane concentration, as well as postoperatively for pain by using FLACC (F = Face, L = Leg, A = Activity, C = Cry, C = Consolability), pain score and for sedation by using four point sedation score.

Results:

The mean duration of analgesia was 10–18 h in Group BT while in Group BF it was 7-11 h. The postoperatively period up to 1½ h, Group BF had higher sedation score up to two as compared to that below one on Group BT.

Conclusion:

Caudal tramadol significantly prolongs the duration of analgesia as compared to caudal fentanyl without any side effects.

Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study

AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions.

METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral, faces, legs, activity, cry and consolability (FLACC) scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright’s modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test.

RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study.

CONCLUSION: Drawings could not act as surrogate measure of child’s pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium.

Ambulatory pain evaluation based on heart rate variability analysis: Application to physical therapy

Pain assessment is critical for efficient pain management. Clinicians usually use self-report or behavioral pain scales. In practice, the choice of the most adaptive scale depends on several parameters like the clinical context, the patient consciousness or its age, but all evaluation scales are known to be more or less subjective and to present high inter and intra individual variability. Recently, several innovative medical devices have been developed in order to provide to the clinicians a physiological measure of pain. These technologies are mainly used for the continuous monitoring of patients in intensive care or during surgery. As an example, we have developed a heart rate variability analysis based technology for analgesia/nociception monitoring in patients undergoing surgery under general anesthesia. Even if this technology is now used in other clinical settings, the resulting device presents some mobility constraints. In this paper, we describe the adaptation of this technology to the ambulatory pain evaluation and its clinical validation in the particular context of physical therapy. In the frame of this validation, we showed the device usability and efficiency for pain evaluation during physical therapy sessions.

Cone-like resection, fistulectomy and mucosal rectal sleeve partial endorectal pull-through in paediatric Crohn's disease with perianal complex fistula

BACKGROUND

Perianal abscesses and fistulae have been reported in approximately 15% of patients with paediatric Crohn's disease and they are associated with poor quality of life. Several surgical techniques were proposed for the treatment of perianal Crohn's disease, characterized by an elevated incidence of failure, incontinence, and relapse. Aim of our study was to present the technical details and results of our surgical technique in case of recurrent, persistent, complex perianal ano-rectal destroying Crohn's disease not responding to medical treatment.

METHODS

Data of patients who underwent surgical treatment (cone-like resection, fistulectomy, sphincter reconstruction, endorectal advancement sleeve flaps like in Soave endorectal pull-through) for complicated high-level trans, inter or suprasphincteric fistulae between January 2009 and June 2014 were retrospectively reviewed.

RESULTS

20 surgical procedures were performed in 11 patients (males 72.7%) with transsphincteric (n=5), intersphincteric (n=4) and suprasphincteric (n=2) fistulae. Three patients needed a second treatment. Two patients needed more than 2 surgeries and one temporary colostomy. No patient presented anal incontinence at 15 months' median follow-up.

CONCLUSIONS

Although several procedures may be required to obtain a complete remission of perianal lesions, in our series the proposed surgical technique seemed effective and safe, preserving anal continence in all treated cases and reducing the need of faecal diversion.

Children's voices--Differentiating a child perspective from a child's perspective

OBJECTIVE

The aim of this paper was to discuss differences between having a child perspective and taking the child's perspective based on the problem being investigated.

METHODS

Conceptual paper based on narrative review.

RESULTS

The child's perspective in research concerning children that need additional support are important. The difference between having a child perspective and taking the child's perspective in conjunction with the need to know children's opinions has been discussed in the literature. From an ideological perspective the difference between the two perspectives seems self-evident, but the perspectives might be better seen as different ends on a continuum solely from an adult's view of children to solely the perspective of children themselves. Depending on the research question, the design of the study may benefit from taking either perspective. In this article, we discuss the difference between the perspectives based on the problem being investigated, children's capacity to express opinions, environmental adaptations and the degree of interpretation needed to understand children's opinions.

CONCLUSION

The examples provided indicate that children's opinions can be regarded in most research, although to different degrees.

The Effect of Directed Medical Play on Young Children's Pain and Distress During Burn Wound Care

Directed medical play is used to reduce children's pain and distress during medical treatment. In this pilot study, young children who attended the burn clinic received either directed medical play provided by a child life specialist or standard preparation from the burn clinic nurse to prepare for their first dressing change. Data were collected using validated instruments. Children who participated in medical play experienced less distress during their dressing change (M = 0.5, n = 12) than did those receiving standard preparation (M = 2.0, n = 9). Children who received standard care reported a 2-point increase in pain during the procedure, whereas children who participated in medical play reported a 1-point increase. Change in parental anxiety was similar for both groups. Parent satisfaction was higher for caregivers who observed medical play than standard preparation. Although all findings were in the hypothesized direction, none was statically significant, most likely because of the small sample size.

The incidence of idiopathic musculoskeletal pain in children with upper extremity injuries

INTRODUCTION

Children with upper extremity injuries may report persistent pain beyond the period of acute injury. In the published literature, it is unclear whether these children develop idiopathic musculoskeletal pain (IMP) such as complex regional pain syndrome (CRPS). The purpose of this study was to determine the incidence rate of IMP after upper extremity injury in school-aged children over a 5-year period and to describe the characteristics of these children.

METHODS

A retrospective case series was conducted of all children aged 8-18 years with an upper extremity injury who attended the outpatient hand clinic in a tertiary care pediatric hospital.

RESULTS

A reported incidence rate of IMP was 1.9% over a 5-year period in the 879 children reviewed. Girls were more likely to have IMP. The categorical distribution of the type, etiology and anatomical location of injury was proportionately different for those with IMP compared to those without documentation of IMP. In comparison, a higher percentage of children with IMP reported disproportionate pain and hypersensitivity or neuropathic pain symptoms compared to the children who had pain from a known etiology.

CONCLUSION

The incidence rate of IMP after upper extremity injury in school-aged children is low. Some common characteristics of this population that may help clinicians identify these children and make timely referrals for treatment include female gender, disproportionate pain, previously seen by multiple specialists, generalized injury in the hand, unspecific etiology or type of injury and unremarkable x-rays.

Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents

OBJECTIVE

To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy. 

METHODS

26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias. 

RESULTS

Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy.

CONCLUSIONS

Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved.

Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents

OBJECTIVE

To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy. 

METHODS

26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias. 

RESULTS

Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy.

CONCLUSIONS

Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved.

Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children

BACKGROUND

Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting.

METHODS

A prospective cohort study was performed including 167 children aged 0-12 years, undergoing AD using an adenotome and ATE using the guillotine technique in day care. Children undergoing AD received acetaminophen pre- and postoperatively. Children undergoing ATE received acetaminophen and diclofenac preoperatively, sufentanyl postoperative and a prescription of around-the-clock treatment with acetaminophen and diclofenac at home. Pain intensity and analgesic consumption were recorded in hospital using the Faces, Legs, Activity, Cry and Consolability-scale (FLACC), as well as during a 1-week follow-up period at home using the Parents' Postoperative Pain Measure (PPPM) and Visual Analogue Scale (VAS) scores.

RESULTS

All children left the recovery room with adequate pain scores and were discharged with a median VAS of two after ATE and one after AD. The PPPM and VAS scores were highest at the first measurement at home for AD patients (VAS = 2.0 and PPPM = 1.5) and ATE patients (VAS = 4.5 and PPPM = 9). On the second postoperative day, AD patients scored 0.0 points on both VAS and PPPM. ATE patients scored at that time 3.0 point on the VAS and 6.0 points using the PPPM. Despite high adherence to pain treatment, daytime activities normalized after an average of 2 and 7 days after AD and ATE, respectively.

CONCLUSION

Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.

Introducing LAPPS (Liverpool Anticipatory Procedural Pain Score): the pragmatic development of an innovative approach to predicting and treating procedural pain and distress in children

Removal of chest drains is a painful procedure and distresses patients, parents and nurses. To identify problems and improve management we developed a concerted approach to both assessment and treatment using audit. An initial prospective audit of post-op cardiac children undergoing chest drain +/- pacing wire removal was undertaken. A clinical tool was developed, to assess children before procedures and provide a treatment plan aimed at reducing pain and distress. The tool incorporated the intensity of the procedure, the child's usual response to procedures and previous experience. The treatment protocol included drug and non-drug therapies. The initial audit of 91 children confirmed that pain and distress were problems. It highlighted inconsistencies in management as a common feature. Following introduction of the LAPPS tool and treatment protocol, a second audit of 72 children was undertaken. Although only 46 per cent of pathways were satisfactorily completed, the percentage of patients described as 'inconsolable, screaming and withdrawn' reduced from 29 per cent to 9 per cent. Introduction of the LAPPS assessment tool and treatment protocol reduced pain and distress during removal of chest drains. Research is needed to test the psychometrics of the tool and the effectiveness of the treatment protocol prior to wider use.

Active and passive distraction in children undergoing wound dressings

The aim of this study was to test how distraction influences pain, distress and anxiety in children during wound care. Sixty participants aged 5-12 years were randomized to three groups: serious gaming, the use of lollipops and a control group. Self-reported pain, distress, anxiety and observed pain behaviour were recorded in conjunction with wound care. Serious gaming, an active distraction, reduced the observed pain behaviour and self-reported distress compared with the other groups. A sense of control and engagement in the distraction, together, may be the explanation for the different pain behaviours when children use serious gaming.

Psychometric validation of Emotional Reaction Instrument-English to measure American children's emotional responses to hospitalisation

AIMS AND OBJECTIVES

The aim of this study was to test the initial psychometric properties of the Emotional Reactions Instrument-English with hospitalised American children, ages 7-12 years, in the USA.

BACKGROUND

Children's negative emotional responses have been a subject of concern for paediatric clinicians and researchers, especially because negative emotional responses following or during hospitalisation are associated with adverse patient outcomes. Existing self-report paediatric instruments have a number of limitations including lack of clinical feasibility and psychometric evidence.

DESIGN

A survey and psychometric approach was used to test initial reliability and validity of the Emotional Reactions Instrument-ENGLISH.

METHODS

Two hundred hospitalised American children, 7-12 years of age, who were admitted to a Children's Hospital in the USA were recruited for this study. The children were administered the Emotional Reactions Instrument-English, the Facial Affective Scale, and a demographic form.

RESULTS

Internal consistency was supported by a Cronbach's alpha of 0·83 for the total scale. Alpha coefficients for subscales ranged from 0·59-0·82. Construct validity was tested with exploratory factor analysis. Through principal component analysis, four factors were identified that explained 64% of the variance. Concurrent validity was supported by most items in the Emotional Reactions Instrument-English being significantly correlated with the Facial Affective Scale (r = 0·18-0·59). The instrument can be administered to hospitalised children in 5-10 minutes.

CONCLUSIONS

The results of this exploratory study provide initial support for the psychometric adequacy of the Emotional Reactions Instrument-English with hospitalised American children ages 7-12 years. Further testing of the Emotional Reactions Instrument-English is required to validate the subscales and evaluate the instrument's use with children of different ages, race and ethnicity.

RELEVANCE TO CLINICAL PRACTICE

This study introduces a new, clinically feasible instrument to measure children's diverse emotional responses to hospitalisation.

Children's experiences of procedural pain management in conjunction with trauma wound dressings

AIM

This paper is a report of the experiences of children (5-10 years) of procedural pain when they underwent a trauma wound care session.

BACKGROUND

Procedural pain in conjunction with trauma wound care often induces anxiety and distress in children. Children need to alleviate pain and avoid the development of fear in conjunction with examinations and treatments. The nurse could help children to reach this goal by using the comfort theory, which describes holistic nursing in four contexts: physical, psychospiritual, environmental and sociocultural. Few studies have focused on children's experiences of comforting activities in conjunction with trauma wound dressings.

METHODS

This study was conducted between May 2008 and January 2010. Thirty-nine participants aged 5-10 were consecutively included in this study. The wound care session was standardized for all the participants, and semi-structured qualitative interviews with open-ended questions were conducted with all the children in conjunction with the procedure. All the interviews were transcribed verbatim and analysed with qualitative content analysis.

FINDINGS

Four themes were identified: clinical competence, distraction, participation and security. The children were helped to reach comforting activities to enhance pain management.

CONCLUSION

Children require more than just analgesics in wound care. They also need to experience security and participation in this context. When children feel clinical competence in wound care, they trust the nurse to carry out the wound dressing and instead can focus on the distraction that increases their positive outcomes.

Efficacy assessment in paediatric studies

Even though the regulatory authorities to some extent accept the extrapolation of efficacy data from adults to paediatric patients, it is often the case that differences in the disease process and the developmental stage of the children prevent the extrapolation of efficacy in these populations. Where efficacy studies are needed, the development, validation, and employment of different endpoints for specific age and developmental subgroups become necessary. Children are in continuous development and any measure to assess the efficacy of an intervention should take carefully into account how this development affects the endpoints, including the performance capacity of the child and differences in the condition and symptoms presented. Clinical endpoints that are used in the adult trials to evaluate treatment effect may not be suitable in paediatric studies. The development of surrogate endpoints for benefit and risk assessment in children is necessary. Collaboration between the academic researchers, pharmaceutical industry, and regulatory authorities is needed to meet the challenges in proper validation of biomarkers and surrogate endpoints in paediatric trials.

School-aged children's experiences of postoperative music medicine on pain, distress, and anxiety

AIM

To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school-aged children who had undergone day surgery.

BACKGROUND

Music medicine has been proposed to reduce distress, anxiety, and pain. There has been no other study that evaluates effects of music medicine (MusiCure) in children after minor surgery.

METHODS

Numbers of participants who required analgesics, individual doses, objective pain scores (Face, Legs, Activity, Cry, Consolability [FLACC]), vital signs, and administration of anti-emetics were documented during postoperative recovery stay. Self-reported pain (Coloured Analogue Scale [CAS]), distress (Facial Affective Scale [FAS]), and anxiety (short State-Trait Anxiety Inventory [STAI]) were recorded before and after surgery. In conjunction with the completed intervention semi-structured qualitative interviews were conducted.

RESULTS

Data were recorded from 80 children aged 7-16. Forty participants were randomized to music medicine and another 40 participants to a control group. We found evidence that children in the music group received less morphine in the postoperative care unit, 1/40 compared to 9/40 in the control group. Children's individual FAS scores were reduced but no other significant differences between the two groups concerning FAS, CAS, FLACC, short STAI, and vital signs were shown. Children experienced the music as 'calming and relaxing.'

CONCLUSIONS

Music medicine reduced the requirement of morphine and decreased the distress after minor surgery but did not else influence the postoperative care.