• Child
• Dental anaesthesia
• Fear
• Local anaesthesia
• Pain

• Humans
• Child
• Nerve Block/methods
• Nerve Block/instrumentation
• Mandibular Nerve
• Anesthesia, Dental/methods
• Anesthesia, Dental/instrumentation
• Male
• Female
• Pain Measurement
• Syringes
• Heart Rate
• Anesthetics, Local/administration & dosage
• Patient Preference

• 2021/09 Pamukkale Üniversitesi

• Acute pain
• Bed bath
• Pain
• Practical nursing
• Procedural pain

• Humans
• Prospective Studies
• Baths/adverse effects
• Baths/methods
• Female
• Male
• Middle Aged
• Pain Measurement/methods
• Aged
• Adult
• Pain Management/methods
• Aged, 80 and over
• Pain/etiology

• Audio analgesia
• Behavior
• Dental anxiety
• Dental cavity preparations
• Pediatric dentistry

• Humans
• Child
• Female
• Male
• Dental Anxiety/prevention & control
• Dental Anxiety/psychology
• Adolescent
• Smartphone
• Mobile Applications

• Manipal Academy of Higher Education, Manipal

• Humans
• Ketamine/therapeutic use
• Ketamine/administration & dosage
• Tonsillectomy
• Adenoidectomy
• Male
• Female
• Pain, Postoperative/drug therapy
• Pain, Postoperative/prevention & control
• Child, Preschool
• Child
• Interleukin-6/blood
• C-Reactive Protein/analysis
• Analgesics/therapeutic use
• Double-Blind Method
• Pain Measurement
• Inflammation
• Inflammation Mediators/blood

• Analgesia
• Children
• Dexmedetomidine
• Esketamine
• Intranasal
• Procedure
• Sedation

• Humans
• Dexmedetomidine/administration & dosage
• Nitrous Oxide/administration & dosage
• Administration, Intranasal
• Child
• Female
• Male
• Child, Preschool
• Adolescent
• Prospective Studies
• Hypnotics and Sedatives/administration & dosage
• Conscious Sedation/methods
• Pain Measurement
• Pain Management/methods
• Administration, Inhalation
• Analgesics, Non-Narcotic/administration & dosage

• University of Helsinki (including Helsinki University Central Hospital)

• behavior management
• dental anxiety
• external vibration
• pediatric dentistry
• precooling

• Cognitive functions
• Cortical EEG changes
• Full mouth rehabilitation
• General anesthesia
• Pain scale

• Humans
• Child
• Male
• Female
• Pain Measurement
• Cognition/physiology
• Mouth Rehabilitation/methods
• Anesthesia, General
• Electroencephalography
• Cerebral Cortex/physiopathology

• Tanta University

• Analgesia
• Children
• Dexmedetomidine
• Esketamine
• Intranasal
• Procedure
• Sedation

• Child
• Humans
• Child, Preschool
• Dexmedetomidine
• Pain
• Pain Management
• Analgesia
• Ketamine

• Päivikki ja Sakari Sohlbergin Säätiö
• Stiftelsen Samariten
• Finska Läkaresällskapet
• University of Helsinki (including Helsinki University Central Hospital)

• children
• postoperative negative behavioral changes
• postoperative recovery
• preoperative anxiety

• Humans
• Child
• Midazolam
• Clonidine
• Anesthesia
• Anxiety
• Postoperative Period

• Umeå Universitet
• Västerbotten Läns Landsting

• chemotherapy
• febrile neutropenia
• lymphoma
• pediatric cancer
• pegylated granulocyte colony-stimulating factor

• CSPC Baike (Shandong) Biopharmaceutical Co., Ltd.

• analgesics, opioid
• pain, postoperative
• pediatrics
• regional anesthesia
• ultrasonography

• accident and emergency
• acute pain
• child health
• clinical
• decision-making
• emergency care
• pain
• pain assessment
• pain management
• professional
• professional issues

• Child
• Humans
• Acute Pain/diagnosis
• Acute Pain/drug therapy
• Pain Measurement
• Emergency Service, Hospital
• Triage
• Analgesics

Emergence delirium (ED) is associated with behavioral disturbances and psychomotor agitation, increased risk of selfinjury, delayed discharge, and parental dissatisfaction with quality of care. Otolaryngology procedures are associated with an increased risk of ED. The aims of this study were to determine the prevalence of ED in children who had tonsillectomy and adenoidectomy (T&A), assess the characteristics of children who had ED, and ascertain the recovery times of patients with ED.

Charts of patients who had tonsillectomy and adenoidectomy between Jan 1, 2018 and March 26, 2020 at a tertiary children's hospital were reviewed. Data collection included demographics, body mass index, indication for T&A, Pediatric Anesthesia Emergence Delirium (PAED) score, American Society of Anesthesiologists (ASA) physical status classification, total anesthesia time, postanesthesia care phase I time, and postanesthesia care phase II time.

Of the 4974 patients who underwent T&A, ED occurred in 1.3% of patients. Toddlers (2.9%) and male children (1.6%) had a significantly higher prevalence of ED. Prevalence of ED was similar amongst patients with recurrent tonsillitis, patients with obstructive sleep disordered breathing, and patients with both obstructive sleep apnea (OSA) and recurrent tonsillitis. The prevalence of ED was not different amongst ASA I, ASA II, and ASA III. Males with ED had longer total anesthesia times (41 v. 34 minutes, p=0.02) and ASA I patients with ED had longer phase I times (p=0.04) in the postanesthesia care unit (PACU). There was no significant difference in total anesthesia time, phase I time, or phase II time when compared across the subgroups of gender, age, indication for T&A, severity of obstructive sleep apnea (OSA), and ASA score.

Males, toddlers, and preschool-age children were more likely to have ED. Males with ED had longer total anesthesia times. ED was associated with longer phase I times in ASA I patients.

• Consistency
• Dyads
• Meta-analysis
• Metaregression
• Pediatric pain ratings

• Anxiety
• Burn
• Injury
• Pain
• Pediatrics

Emergence agitation (EA) has a negative effect on the recovery from general anesthesia in children. This study aimed to evaluate the effectiveness of intravenous ibuprofen in reducing the incidence of EA in children.

This randomized, double-blind, placebo-controlled, single-center study analyzed data from patients aged 3–9 years undergoing tonsillectomy under general anesthesia with propofol and remifentanil. These patients were randomly assigned to receive either the ibuprofen or the placebo intraoperatively. The primary endpoint was a between-group difference in the incidence of EA at 15 min following extubation. EA was defined as Pediatric Anesthesia Emergence Delirium score ≥10. The secondary endpoint included the associated factors of EA.

Eighty-nine patients were included in the study. Ibuprofen decreased the incidence of EA at 15 min following extubation (8.9% in the treatment group vs 34.1% in the control group; odds ratio [OR], 0.261; 95% confidence interval [CI], 0.094–0.724; P=0.004). Compared with the control group, there was a significant reduction in the number of rescue fentanyl doses (P=0.045), and fewer patients experienced moderate to severe pain at 15 min following extubation in the treatment group (P=0.048). Upon logistic regression analysis, high modified Pediatric Anesthesia Behavior and pain scores following surgery were considered the risk factors related to EA (OR, 8.07; 95% CI, 1.12–58.07, P=0.038 and OR, 2.78; 95% CI, 1.60–4.82, P<0.001, respectively). Ibuprofen administration was the protective factor related to EA (OR, 0.05; 95% CI, 0.01–0.67, P=0.023).

Intraoperative ibuprofen infusion can significantly reduce the incidence of EA following general anesthesia with propofol and remifentanil in children.

The study was registered with the Chinese Clinical Trial Registry on 7 April 2021 (number: ChiCTR2100045128; https://www.chictr.org.cn/edit.aspx?pid=124595&htm=4).

• research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

• Amblyopia
• Child
• Pediatrics ophthalmology
• Tablet
• Visual acuity
• Visual screening
• eMOVA test

• Activity
• Cry
• Face
• Legs
• Pin removal
• and Consolability
• anxiety
• fracture
• heart rate
• implant
• pediatrics
• supracondylar
• trauma

The aim of the study was to compare the effect of a stress ball, an active distraction technique with audio-visual eyeglasses, a passive distraction technique during local anaesthesia administration, on dental anxiety (primary outcome), behaviour and pain levels of children (secondary outcomes).

In this randomised controlled parallel arm trial involving 123 children aged 8–12 years, who required dental treatment under inferior alveolar nerve block, children were randomly allocated into the following three groups: Group 1: Stress ball, Group 2: Audio-visual eyeglasses, Group 3: Control group (basic behaviour guidance without distraction). Dental anxiety was measured using modified child dental anxiety scale and pulse rate, behaviour was rated using Venham’s scale and pain was measured by both self-reporting and observational scales.

No significant difference between the groups was observed for dental anxiety, but a significant decrease was seen in dental anxiety scores within all groups. No significant differences were seen between the groups for behaviour ratings and pain scores.

Use of active stress ball distraction or passive audio-visual eyeglasses during local anaesthesia administration decreased dental anxiety but did not result in a significant improvement in the dental anxiety, behaviour and pain levels when compared to basic behaviour guidance without distraction.

The clinical trial was registered at Clinical Trials Registry–India (CTRI Reg no: CTRI/2019/04/018768, Dated 24 April 2019).

The online version contains supplementary material available at 10.1007/s40368-022-00698-7.

• Audio-visual
• Dental care
• Distraction
• Nerve block
• Play therapy

Children with cognitive impairment (CI) are at risk of experiencing pain. Several specific pain rating scales have been developed to date. Thus, the aim of this meta‐analysis was to estimate the degree of reliability of different pain assessment scales for the postoperative pain in children with CI.

PubMed, Scopus and Web of Science databases were approached: all studies validating and/or using pain assessment tool in children (0–20 years) with CI published in English from the 1st of January 2000 to the 1st of January 2022 were included. Only studies reporting the interclass correlation coefficient (ICC) to evaluate the concordance between caregivers’ and external researchers’ scores were eligible.

Twelve studies were included (586 children with CI, 60% males; weighted mean age 9.9 years – range 2–20). Five of them evaluated the Non‐Communicating Children's Pain Checklist‐Postoperative Version (NCCPC‐PV) scale whereas four the original and revised Face, Legs, Activity, Cry, Consolability (FLACC) scale. The analysis showed an overall ICC value of 0.76 (0.74–0.78) for the NCCPC‐PV scale, with a high heterogeneity index (I² = 97%) and 0.87 (0.84–0.90) for the FLACC scale, with a discrete I² index (59%).

The NCCPC‐PV and FLACC pain rating scales showed the strongest evidence for validity and reliability for assessing postoperative pain in children with CI. However, due to the high heterogeneity of the studies available, these results should not be considered conclusive.

This review is focused on the assessment of pain in children with CI in the postoperative period. Simplified observation‐based pain assessment tools that rely on evaluating non‐verbal expressions of pain should be recommended for children with difficulties to communicate their feelings. Even if there is a high degree of heterogeneity in clinical presentations among youth with CI, two tools (NCCPC‐PV and FLACC) have emerged as reliable and valid in this population.

• Analgesia
• Children
• Critically ill
• Delirium
• Sedation
• Trauma

• Aged
• Child
• Cross-Sectional Studies
• Emergency Service, Hospital
• Hospitals, Pediatric
• Humans
• Middle Aged
• Pain/epidemiology
• Pain/etiology
• Pain Measurement

The purpose of this study was to evaluate behavioral strategies to minimize procedural distress associated with in-office tympanostomy tube placement for children without general anesthesia, sedation, or papoose-board restraints. 120 6-month- to 4-year-olds and 102 5- to 12-year-olds were treated at 16 otolaryngology practices. Mean age of children was 4.7 years old (SD = 3.18 years), with more boys (58.1%) than girls (41.9%). The cohort included 14% Hispanic or Latinx, 84.2% White, 12.6% Black, 1.8% Asian and 4.1% ‘Other’ race and ethnicity classifications. The in-office tube placement procedure included local anesthesia via lidocaine/epinephrine iontophoresis and tube placement using an integrated and automated myringotomy and tube delivery system. Behavioral strategies were used to minimize procedural distress. Anxiolytics, sedation, or papoose board were not used. Pain was measured via the faces pain scale-revised (FPS-R) self-reported by the children ages 5 through 12 years. Independent coders supervised by a psychologist completed the face, legs, activity, cry, consolability (FLACC) behavior observational rating scale to quantify children’s distress. Mean FPS-R score for tube placement was 3.30, in the “mild’ pain range, and decreased to 1.69 at 5-min post-procedure. Mean tube placement FLACC score was 4.0 (out of a maximum score of 10) for children ages 6 months to 4 years and was 0.4 for children age 5–12 years. Mean FLACC score 3-min post-tube placement was 1.3 for children ages 6 months to 4 years and was 0.2 for children age 5–12 years. FLACC scores were inversely correlated with age, with older children displaying lower distress. The iontophoresis, tube delivery system and behavioral program were associated with generally low behavioral distress. These data suggest that pediatric tympanostomy and tube placement can be achieved in the outpatient setting without anxiolytics, sedatives, or mechanical restraints.

• Distraction
• Myringotomy
• Pediatric
• Preparation techniques
• Procedural distress
• Tympanostomy tube placement

• Child
• Infant
• Pain measurement
• Psychometrics
• Sensitivity and specificity
• Visual Analogue Scale

• epidural analgesia
• functional neurosurgery
• opioid
• pain management
• selective dorsal rhizotomy

• Analgesia, Epidural/methods
• Analgesics, Opioid/therapeutic use
• Cerebral Palsy/surgery
• Child
• Child, Preschool
• Cohort Studies
• Female
• Humans
• Male
• Pain Management/methods
• Pain, Postoperative/etiology
• Pain, Postoperative/therapy
• Retrospective Studies
• Rhizotomy/adverse effects

• craniotomy
• opioid
• pain management
• sumatriptan

• R25 NS079198 NINDS NIH HHS

• Children
• Local Anesthesia
• Pain Perception
• Palate
• Pre-cooling
• Topical Anesthetic

• acute pain
• pain management
• pediatrics

• ICF-CY
• clinical assessment tool
• nursing
• paediatric cancer
• young child

• Procedural pain
• distress
• haematology oncology
• hypnotic communication
• nurses’ training
• paediatric

This study evaluated the efficacy of three intraoral topical anesthetics in reducing the injection needle prick pain from local anesthetic among children aged 7–11 years old.

It is a prospective, Interventional, parallel design, single-blind, randomized clinical trial in which subjects (n=90) aged 7–11 years were included in the study based on an inclusion criteria. Subjects were divided into three groups based on computer-generated randomization with an allocation ratio of 1:1:1. Groups A, B, and C received benzocaine 20% jelly (Mucopain gel, ICPA health products Ltd, Ankleshwar, India), cetacaine anesthetic liquid (Cetylite Industries, Inc, Pennsauken, NJ), and EMLA cream (2% AstraZeneca UK Ltd, Luton, UK), respectively, according to manufacturer's instructions, for 1 minute prior to local anesthetic injection. After application of topical anesthetic agent, for all the groups, baseline pre-operative (prior to topical anesthetic administration) and post-operative scores (after local anesthetic administration) of pulse rate was recorded using Pulse oximeter (Gibson, Fingertip Pulse Oximeter, MD300C29, Beijing Choice Electronic). Peri-operative (i.e., during the administration of local anesthesia) scores were recorded using Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Modified Children hospital of Eastern Ontario Pain Scale (CPS) behavior rating scale, and Faces Pain Scale (FPS-R) – Revised (For self-reported pain). Direct self-reported and physiological measures were ascertained using FPS-R – Revised and Pulse oximeter, respectively, whereas CPS and FLACC scales assessed behavioral measures. To test the mean difference between the three groups, a one way ANOVA with post hoc tests was used. For statistical significance, a two-tailed probability value of P < 0.05 was considered as significant.

The Cetacaine group had significantly lower pain scores for self-report (P < 0.001), behavioral, and physiological measures (P < 0.001) than the other two groups. However, there was no significant difference between the Benzocaine group and EMLA group during palatal injection prick.

Cetacaine can be considered as an effective topical anesthetic agent compared to benzocaine 20% jelly (Mucopain gel) and EMLA cream.

• Cetacaine
• Children
• Injections
• Palate
• Topical Anesthesia

• Cerebral palsy
• Pain
• Post-operative assessment

• Electroencephalography
• Near infrared spectroscopy
• Neonate
• Nociception
• Pain
• Prematurity

Paediatric pain and its assessment and management are challenging for medical professionals, especially in an urgent care environment. Patients in a paediatric emergency room (PER) often undergo painful procedures which are an additional source of distress, anxiety, and pain. Paediatric procedural pain is often underestimated and neglected because of various myths, beliefs, and difficulties in its evaluation and treatment. However, it is very different from other origins of pain as it can be preventable. It is known that neonates and children can feel pain and that it has long-term effects that last through childhood into adulthood. There are a variety of pain assessment tools for children and they should be chosen according to the patient’s age, developmental stage, communication skills, and medical condition. Psychological factors such as PER environment, preprocedural preparation, and parental involvement should also be considered. There are proven methods to reduce a patient’s pain and anxiety during different procedures in PER. Distraction techniques such as music, videogames, virtual reality, or simple talk about movies, friends, or hobbies as well as cutaneous stimulation, vibration, cooling sprays, or devices are effective to alleviate procedural pain and anxiety. A choice of distraction technique should be individualized, selecting children who could benefit from nonpharmacological pain treatment methods or tools. Nonpharmacological pain management may reduce dosage of pain medication or exclude pharmacological pain management. Most nonpharmacological treatment methods are cheap, easily accessible, and safe to use on every child, so it should always be a first choice when planning a patient’s care. The aim of this review is to provide a summary of paediatric pain features, along with their physiology, assessment, management, and to highlight the importance and efficacy of nonpharmacological pain management in an urgent paediatric care setting.

• acute pain
• management
• nonpharmacological
• paediatric pain
• pain assessment
• procedural pain

• IV = intravenous
• OME = oral morphine equivalent
• POD = postoperative day
• PSM = paraspinal muscle
• ROI = region of interest
• hemilaminotomy
• laminectomy
• muscle atrophy
• pain control
• pediatric spine
• split laminotomy

• Adolescent
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Laminectomy/classification
• Laminectomy/methods
• Magnetic Resonance Imaging
• Male
• Pain Measurement
• Postoperative Complications/diagnostic imaging
• Postoperative Complications/physiopathology
• Retrospective Studies
• Spinal Canal/surgery
• Spinal Cord Neoplasms/diagnostic imaging
• Spinal Cord Neoplasms/surgery
• Thoracic Vertebrae/surgery
• Treatment Outcome
• Young Adult

• FLACC scale
• Face, Legs, Activity, Cry, and Consolability scale
• pain assessment
• psychometric evaluation
• reliability
• validation

• Virtual reality
• botulinum
• spasticity

• Blood sampling
• Children
• Distraction
• Flippits
• Pain

To review our experience and results in the diagnosis and treatment of urethral prolapse (UP) in Chinese girls.

We conducted a retrospective chart review of 89 consecutive girls (aged <16 years) with UP and without other complications, who received treatment for UP from January 1999 to January 2015 (a study period of 16 years) at the Children’s Hospital of Chongqing Medical University, China. Data analysed included: age, symptoms, clinical findings, predisposing factors, management, and outcomes.

The presenting symptoms in the 89 girls were: mass (54 girls), bleeding (34), and dysuria/straining at micturition (one). In all, 14 patients received conservative treatment as their symptoms were mild, and 75 were successfully treated by excision of the prolapsed urethral mucosa or ligation over a Foley catheter, as their symptoms were severe and recurred too frequently to be managed conservatively. The mean postoperative length of stay for ligation was 7.76 days and for excision was 4.57 days. Ligation over a Foley catheter had a longer hospital stay.

UP is a rare condition occurring in prepubertal girls, evidenced by a urethral mass and bleeding. Increased physician awareness and early recognition of UP avoids unnecessary examinations and patient anxiety.

• BMI, body mass index
• China
• FLACC, Face, Legs, Activity, Cry, Consolability (pain scale)
• Girls
• Management
• UP, urethral prolapse
• Urethral prolapse