The United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group is a multi-disciplinary expert panel created to produce consensus guidelines on sedation and analgesia in critically ill children and forward knowledge in these areas. Sedation and analgesia are recognised as important areas of critical care practice and adult clinical practice guidelines in these fields remain amongst the most popular of those produced by the Society of Critical Care Medicine. However, similar clinical practice guidelines have not previously been produced for the critically ill paediatric patient. A modified Delphi technique was used to allow the Working Group to anonymously consider draft recommendations in three Delphi rounds with predetermined levels of agreement. This process was supported by a total of four consensus conferences. Once consensus had been reached, a systematic review of the available literature was carried out. A set of consensus guidelines was produced including 20 key recommendations, 10 relating to the provision of analgesia and 10 relating to the sedation of critically ill children. An evaluation of the existing literature supporting these recommendations is provided. Multi-disciplinary consensus guidelines for maintenance sedation and analgesia in critically ill children have been successfully produced and are supported by levels of evidence (excluding sedation and analgesia for procedures and excluding neonates). The working group has highlighted the paucity of high-quality evidence in these important clinical areas and this emphasises the need for further randomised clinical trials in this area.

Consensus guidelines on sedation and analgesia in critically ill children

Pain Management Knowledge and Attitudes of Baccalaureate Nursing Students and Faculty

Background Pain management is a key component of patient satisfaction and well-being in acute care settings. Nurses spend more time with patients than any other members of the health care team and play a major role in pain management. Methods This descriptive study in an urban tertiary care hospital explored the knowledge and attitudes of registered nurses regarding pain management. A modified version of the Ferrell and McCaffery Knowledge and Attitudes Survey Regarding Pain was used. Results Forty-nine percent of respondents achieved a passing score of 80% or more. Pharmacology questions were the least likely to be answered correctly. Negative correlations were found between score and demographic variables of age and experience. A positive correlation between score and educational level was noted. Conclusion Nurses require ongoing education on pain management, particularly pharmaceutical agents. However, this education alone is insufficient to substantively improve patients' pain experiences.

Nurses' knowledge and attitudes regarding pain management in hospitalized adults.

Aims: The purpose of this study was to assess the effectiveness of an acute pain educational programme in improving nurses' knowledge, skills and attitudes around postoperative pain management. Background: Poor postoperative pain management is consistently reported as a problem for patients (Chung and Lui, 2003; Klopper et al, 2006; Bell and Duffy, 2009). This is often attributed to health professionals' lack of knowledge and access to training programmes, which have been cited as barriers to effective pain management (Wilkes et al, 2003; Dihle et al 2006). The Acute Pain Service (APS) team at HSE Mid-Western Regional Hospital, Limerick, and the Centre for Nurse and Midwifery Education developed a training programme for nurses in pain management based on the International Association for the Study of Pain (2005) curriculum for nurses. Methods: A convenience sample of 59 nurses attending an educational programme on acute pain management was studied. Validated questionnaires were completed before, immediate...

Effect of education on knowledge, skills and attitudes around pain

Acute Compartment Syndrome

Pain produces a physiological stress response that includes increased heart and breathing rates to facilitate the increasing demands of oxygen and other nutrients to vital organs. Failure to relieve pain produces a prolonged stress state, which can result in harmful multisystem effects. Good acute pain management is an essential part of holistic nursing care.

Understanding the physiological effects of unrelieved pain.

Despite major advances in the management of pain since the Royal College of Surgeons and the Royal College of Anaesthetists announced in 1990 that postoperative pain management in British hospitals was inadequate, pain continues to be an unacceptable but common sequel to surgery (Wood, 2002). Pain assessment is simple, but unfortunately it is infrequently performed. When clinicians do not obtain pain ratings from patients they are unlikely to underestimate the patients' pain. Improving pain management requires that pain is recognised as a priority and that nurses are encouraged to play an active and pivotal role within the multidisciplinary team to recognise, prevent and treat it.

Barriers to the provision of effective pain management.

Middleton, C. (2003) Compartment syndrome: the importance of early diagnosis. Nursing Times; 99: 21, 30–32. Compartment syndrome is an acute orthopaedic emergency with a variety of causes, the most common following trauma to the limbs. Necrosis of muscle, nerve and skin tissue may result owing to oxygen deprivation. Early detection and appropriate treatment are essential if irreversible damage is to be avoided.

Compartment syndrome: the importance of early diagnosis.

Almost all patients who undergo amputation suffer 'phantom sensations', a sensory perception of the missing limb, possibly caused by a neural imprint or memory of the limb within the brain. The patient may experience abnormal kinaesthetic sensation, such as the feeling that the limb is in an abnormal position. Perceived changes in length, size or temperature of the limb are also common. Some of these people will go on to develop phantom limb pain (PLP). Appropriate aggressive pain management is required immediately postamputation in an attempt to avoid chronic PLP.

The causes and treatments of phantom limb pain.

Rib fractures are a common injury to the chest. The mainstay of treatment is adequate analgesia coupled with meticulous respiratory care in order to prevent complications. Treatment can be as an outpatient, but patients with more severe fractures may be admitted to hospital for oxygen therapy, ventilation, aggressive analgesic techniques and physiotherapy. Significant morbidity and mortality rates have been reported with rib fractures. To avoid complications, accurate diagnosis, adequate analgesia and effective physiotherapy are essential.

Carolyn Middleton

Papers

Understanding the physiological effects of unrelieved pain.

Barriers to the provision of effective pain management.

Compartment syndrome: the importance of early diagnosis.

The causes and treatments of phantom limb pain.

Management and treatment of patients with fractured ribs.