Showing papers on "Pain scale published in 1998"

Reliability and validity testing of the Michigan Hand Outcomes Questionnaire.

Abstract: In this study, psychometric principles were used to develop an outcomes questionnaire capable of measuring health state domains important to patients with hand disorders. These domains were hypothesized to include (1) overall hand function, (2) activities of daily living (ADL), (3) pain, (4) work performance, (5) aesthetics, and (6) patient satisfaction with hand function. An initial pool of 100 questions was pilot-tested for clarity in 20 patients; following factor analysis, the number of questions was reduced to a 37-item Michigan Hand Outcomes Questionnaire (MHQ). The MHQ, along with the Short Form-12, a generic health status outcomes questionnaire, was then administered to 200 consecutive patients at a university-based hand surgery clinic and was subjected to reliability and validity testing. The mean time required to complete the questionnaire was 10 minutes (range, 7–20 minutes). Factor analysis supported the 6 hypothesized scales. Test-retest reliability using Spearman's correlation demonstrated substantial agreement, ranging from 0.81 for the aesthetics scale to 0.97 for the ADL scale. In testing for internal consistency, Cronbach's alphas ranged from 0.86 for the pain scale to 0.97 for the ADL scale (values >0.7 for Cronbach's alpha are considered a good internal consistency). Correlation between scales gave evidence of construct validity. In comparing similar scales in the MHQ and the Short Form-12, a moderate correlation (range, 0.54–0.79) for the ADL, work performance, and pain scales was found. In evaluating the discriminate validity of the aesthetics scale, a significant difference (p=.0012) was found between the aesthetics scores for patients with carpal tunnel syndrome and patients with rheumatoid arthritis. The MHQ is a reliable and valid instrument for measuring hand outcomes. It can be used in a clinic setting with minimal burden to patients. The questions in the MHQ have undergone rigorous psychometric testing, and the MHQ is a promising instrument for evaluation of outcomes following hand surgery.

The visual analog scale in the immediate postoperative period : Intrasubject variability and correlation with a numeric scale

Abstract: The visual analog scale (VAS) has been used to assess the efficacy of pain management regimens in patients with acute postoperative pain, but its usefulness has not been confirmed in postoperative pain studies. We studied 60 subjects in the immediate postoperative period. The specific data collected were: VAS scores versus an 11-point numeric pain scale; repeatability in VAS scores over a short time interval; and change in VAS scores from one assessment period to the next versus a verbal report of change in pain. The correlation coefficients for VAS scores with the 11-point pain scale were 0.94, 0.91, and 0.95. The repeatability coefficients were 17.6, 23.0, and 13.5 mm. Of the 56 patients who completed all three assessments, only 16 (29%) had repeatability within 5 mm on all three. Some of the changes in VAS scores between assessments were in the direction opposite the verbally reported changes in pain (31%); however, most (92%) were within 20 mm. There was no correlation between the level of sedation, previous pain experience, anxiety, or anticipated pain with consistency in VAS scores. We conclude that any single VAS score in the immediate postoperative period should be considered to have an imprecision of +/- 20 mm. Implications The visual analog scale was developed for assessing chronic pain but is often used in studies of postoperative pain. This study finds that the visual analog scale correlates well with a verbal 11-point scale but that any individual determination has an imprecision of +/- 20 mm.

Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial

Abstract: Context.—Peripheral neuropathy is common in persons infected with the human immunodeficiency virus (HIV) but few data on symptomatic treatment are available.Objective.—To evaluate the efficacy of a standardized acupuncture regimen (SAR) and amitriptyline hydrochloride for the relief of pain due to HIV-related peripheral neuropathy in HIV-infected patients.Design.—Randomized, placebo-controlled, multicenter clinical trial. Each site enrolled patients into 1 of the following 3 options: (1) a modified double-blind 2 × 2 factorial design of SAR, amitriptyline, or the combination compared with placebo, (2) a modified double-blind design of an SAR vs control points, or (3) a double-blind design of amitriptyline vs placebo.Setting.—Terry Beirn Community Programs for Clinical Research on AIDS (HIV primary care providers) in 10 US cities.Patients.—Patients with HIV-associated, symptomatic, lower-extremity peripheral neuropathy. Of 250 patients enrolled, 239 were in the acupuncture comparison (125 in the factorial option and 114 in the SAR option vs control points option), and 136 patients were in the amitriptyline comparison (125 in the factorial option and 11 in amitriptyline option vs placebo option).Interventions.—Standarized acupuncture regimen vs control points, amitriptyline (75 mg/d) vs placebo, or both for 14 weeks.Main Outcome Measure.—Changes in mean pain scores at 6 and 14 weeks, using a pain scale ranging from 0.0 (no pain) to 1.75 (extremely intense), recorded daily.Results.—Patients in all 4 groups showed reduction in mean pain scores at 6 and 14 weeks compared with baseline values. For both the acupuncture and amitriptyline comparisons, changes in pain score were not significantly different between the 2 groups. At 6 weeks, the estimated difference in pain reduction for patients in the SAR group compared with those in the control points group (a negative value indicates a greater reduction for the "active" treatment) was 0.01 (95% confidence interval [CI], −0.11 to 0.12; P =.88) and for patients in the amitriptyline group vs those in the placebo group was −0.07 (95% CI, −0.22 to 0.08; P=.38). At 14 weeks, the difference for those in the SAR group compared with those in the control points group was −0.08 (95% CI, −0.21 to 0.06; P=.26) and for amitriptyline compared with placebo was 0.00 (95% CI, −0.18 to 0.19; P=.99).Conclusions.—In this study, neither acupuncture nor amitriptyline was more effective than placebo in relieving pain caused by HIV-related peripheral neuropathy.

Agreement Between Child and Parent Reports of Pain

Abstract: Objective: Parents are often the primary source of information regarding their children pain in both research and clinical practice. However, parent--child agreement on pain ratings has not been well established. The objective of the present study was to examine agreement between child- and parent-rated pain following minor surgery. Setting: Tertiary care children's hospital. Participants: A total of 110 children (56.4% male) aged 7-12 years undergoing surgery and their parents. Outcome Measures: Parents and children independently rated pain intensity by using a 7-point Faces Pain Scale on the day of the child's surgery and the following 2 days. Results: Correlations (both Pearson's and intraclass correlation coefficients) indicated a highly significant relationship between child and parent ratings. However, kappa statistics indicated only poor to fair agreement beyond chance. Parents tended to underestimate their children's pain on the day of surgery and the following day, but not on the second day following surgery. When children's and parents pain ratings for each of the 3 days were collapsed into a no-pain/low-pain group or a clinically significant pain group, kappa statistics indicated fair to good agreement, Parents demonstrated low levels of sensitivity in identifying when their children were experiencing clinically significant pain. Conclusions: Correlations between parent and child pain reports do not accurately represent the relationship between these ratings and in fact overestimate the strength of the relationship. Parents' underestimation of their child's pain may contribute to inadequate pain control.

Evaluation of the Faces Pain Scale for Use with the Elderly

Abstract: :Objective:The specific objective for this research was to determine initial psychometric properties of the Faces Pain Scale (FPS) as a measure of pain intensity for use with the elderly.Design:The study was descriptive correlational in nature, with nonrandom sampling. A total sample of

What is the optimal dose of botulinum toxin A in the treatment of cervical dystonia? Results of a double blind, placebo controlled, dose ranging study using Dysport

Abstract: OBJECTIVES—Botulinum toxin injections have become a first line therapeutic approach in cervical dystonia. Nevertheless, published dosing schedules, responder rates, and frequency of adverse events vary widely. The present prospective multicentre placebo controlled double blind dose ranging study was performed in a homogenous group of previously untreated patients with rotational torticollis to obtain objective data on dose-response relations. METHODS—Seventy five patients were randomly assigned to receive treatment with placebo or total doses of 250, 500, and 1000 Dysport® units divided between one splenius capitis (0, 175, 350, 700 units) and the contralateral sternocleidomastoid (0, 75, 150, 300 units) muscle. Assessments were obtained at baseline and weeks 2, 4,and 8 after treatment and comprised a modified Tsui scale, a four point pain scale, a checklist of adverse events, global assessment of improvement, and a global rating taking into account efficacy and adverse events. At week 8 the need for retreatment was assessed and then the code was unblinded. For those still responding, there was an open follow up until retreatment to assess the duration of effect. RESULTS—seventy nine per cent reported subjective improvement at one or more follow up visits. Decreases in the modified Tsui score were significant at week 4 for the 500 and 1000 unit groups versus placebo (p<0.05). Additionally positive dose-response relations were found for the degree of subjective improvement, duration of improvement, improvement on clinical global rating, and need for reinjection at eight weeks. A significant dose relation was also established for the number of adverse events overall and for the incidence of neck muscle weakness and voice changes. CONCLUSION—Magnitude and duration of improvement was greatest after injections of 1000 units Dysport®; however, at the cost of significantly more adverse events. Therefore a lower starting dose of 500 units Dysport® is recommended in patients with cervical dystonia, with upward titration at subsequent injection sessions if clinically necessary.

An Analysis of Posture and Back Pain in the First and Third Trimesters of Pregnancy

Abstract: While the incidence of back pain during pregnancy has been shown to be high, few studies have investigated postural changes that occur during pregnancy and their relationship to back pain. The purpose of this study was to determine if posture and back pain changed from the first to the third trimester of pregnancy and whether there was a relationship between the two. Twelve healthy women who were having uncomplicated pregnancies participated in the study. During the first and third trimesters, each subject had their standing posture and back pain assessed by a Metrecom Skeletal Analysis System and a 0- to 10-cm line pain scale, respectively. Repeated measures analysis of variance and Pearson correlation coefficients were calculated on or between back pain and nine posture variables and revealed significant increases in third trimester back pain and postures compared with first trimester back pain (p < .05) and postures for lumbar angle (p < .01), posterior head position (p < .01), right pelvic sagittal ti...

Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration

Abstract: Purpose: In order to better define variables and factors that may influence the pain response to radiation, and to look for a radiation regimen that can assure the highest percentage and the longest duration of pain relief, we performed a prospective, although not randomized, study on patients with bone metastases from various primary sites. Methods and Materials: From December 1988 to March 1994, 205 patients with a total of 255 solitary or multiple bone metastases from several primary tumors were treated in our radiotherapy center with palliative intent. Irradiation fields were treated with three main fractionation schedules: ( 1 ) Conventional fractionation: 40–46 Gy/20–23 fractions in 5–5.5 weeks; ( 2 ) Short course: 30–36 Gy/10–12 fractions in 2–2.3 weeks; ( 3 ) Fast course: 8–28 Gy/1–4 consecutive fractions. Pain intensity was self-assessed by patients using a visual analogic scale graduated from 0 (no pain) to 10 (the strongest pain one can experience). Analgesic requirement was assessed by using a five-point scale, scoring both analgesic strength and frequency (0 = no drug or occasional nonopioids; 1 = Nonopioids once daily; 2 = Nonopioids more than once daily; 3 = Mild opioids (oral codeine, pentazocine, etc.), once daily; 4 = Mild opioids more than once daily; 5 = Strong opioids (morphine, meperidine, etc.). Complete pain relief meant the achievement of a score ≤ 2 in the pain scale or 0 in the analgesic requirement scale. Partial pain relief indicated a score of 3 to 4 or of 1 to 2 on the former and latter scale, respectively. Results: Total pain relief (complete + partial) was observed in 195 (76%) sites, in 158 of which (62%) a complete response was obtained. Metastases from NSC lung tumors appeared to be the least responsive among all primary tumors, with 46% complete pain relief in comparison to 65% and 83% complete relief in breast ( p = 0.04) and in prostate metastases ( p = 0.002), respectively. A significant difference in pain relief was detected among the several ranges of total dose delivered to the painful metastases, with 81%, 65%, and 46% complete relief rates in the 40–46 Gy, 30–36 Gy ( p = 0.03), and 8–28 Gy ( p = 0.0001) dose ranges respectively. A straight correlation between total dose and complete pain relief was confirmed by the curve calculated by the logistic model which shows that doses of 30 Gy or more are necessary to achieve complete pain relief in 70% or more of bone metastases. This correlation holds also for the duration of pain control, as shown by the actuarial analysis of time to pain progression. Multivariate analyses, with complete pain relief and time to pain progression as endpoints show a highly significant effect of radiation dose ( p = 0.0007) and performance status ( p = 0.003), with lower rates of complete pain relief and shorter time to pain progression observed after smaller radiation total doses or higher Eastern Cooperative Oncology Group (ECOG) scores. Conclusion: Although single-dose or short course irradiation is an attractive treatment in reducing the number of multiple visits to radiotherapy departments for patients with painful bone metastases, it is nevertheless clear that aggressive protracted treatments seem to offer significant advantages especially for patients in whom the expected life span is not short.

A simultaneous comparison of three neonatal pain scales during common NICU procedures.

Abstract: Objective: This study evaluated neonatal pain scales during procedures commonly performed in a neonatal intensive care unit. Design: Evaluated were the Neonatal Infant Pain Scale (NIPS), the Comfort scale, and a new scale known as the Scale for Use in Newborns (SUN). Four procedures were scored: intubation, intravenous catheter insertion, endotracheal tube suctioning, and diaper changes. Scoring was done before, during, and after each procedure. Thirty-three patients were tested during 68 procedures with 1,428 scale scores. Results: All scales demonstrated significant changes. In before-versus-during for each procedure, the increase in pain scale score was significant for the NIPS, Comfort scale, and SUN. All three scales also demonstrated a return to baseline (before-vs.-after) for the four procedures, except for the Comfort scale, which remained elevated (p 2.5 kg on sedative or analgesic medications appeared to have procedure-related accentuation and sustained elevation in scale scores, whereas swaddling seemed to provide little added benefit. Conclusions: The pain scale scores identify changes in an infant's behavior/physiologic state. It is unclear whether these changes are totally "pain specific." In comparing the three scales, the SUN overall was a preferable tool because of its ease of use, scale symmetry, and scoring consistency.

Intravenous Ketorolac vs Intravenous Prochlorperazine for the Treatment of Migraine Headaches

Abstract: Objective To compare i.v. ketorolac with i.v. prochlorperazine as the initial treatment of migraine headaches in the ED. Methods A prospective, double-blind comparison study was performed, using a convenience sample of 64 patients suffering from migraine headaches presenting to the ED at a tertiary care university teaching hospital. Patients were randomly assigned to receive either 10 mg of prochlorperazine i.v. or 30 mg of ketorolac i.v.. Patients scored the severity of their headaches using a 10-cm visual analog pain scale. An initial mark was made on the scale at the time of entry into the study and later another mark was made on a new unmarked pain scale 1 hour after medication administration. Changes in pain scores within each treatment group and between groups were analyzed using the Wilcoxon rank sum test. Results Prior to treatment, the patients assigned to receive prochlorperazine had a median score of 9.2 cm (mean +/- SD pain score of 8.3 cm +/- 2.1 cm), while the patients receiving ketorolac had a median score of 9.0 (mean pain score of 8.4 cm +/- 1.7 cm). There was no significant difference between the pain scores of the participants in the 2 groups prior to treatment (p = 0.80). One hour after medication administration, the patients in the prochlorperazine group had a median score of 0.5 cm (mean 2.1 +/- 3.2 cm), while those patients receiving ketorolac had a median pain score of 3.9 (mean 4.0 +/- 3.3 cm). The decrease in pain score was significant for both groups of patients (p = 0.0001). The change in pain score for the patients in the prochlorperazine group (median 7.1) was significantly greater than the change in pain score for the patients in the ketorolac group (median 4.0; p = 0.04). Conclusion Although both drugs were associated with a significant reduction in pain scores, benefit over a placebo agent was not tested. Furthermore, the patients who received prochlorperazine i.v. for migraine headaches had a statistically significant greater decrease in their pain scores than did those receiving ketorolac i.v.

The effect of CO2 insufflation rate on the postlaparoscopic shoulder pain.

Abstract: Shoulder pain (SP) is frequently mentioned in recent literature following laparoscopic operations. In the literature, many causes have been declared to explain shoulder pain after CO2 insufflation, such as direct peritoneal irritation of the CO2 gas, excessive traction of the triangular ligament, and overstretching of the diaphragmatic muscle fibers due to the high rate of insufflation. This study was planned as multicentric, and 76 patients, aged between 35 to 45, were entered into the study. They were all selected by a randomized sampling method, with equal numbers of men and women, to achieve true evaluation. The low flow-rate (LFR) group was insufflated with 2.5 L/min and the high flow-rate (HFR) group with 7.5 L/min. All cases were evaluated by subjective pain classification on postoperative day 3. According to the subjective pain scale method, shoulder pain average was 23.9+/-3.1 in the LFR group and 55.4+/-6.5 in the HFR group. The difference between these groups was significant (p > 0.01). There is no significant difference for the operation time (LFR%: 64+/-15 minutes, HFR: 61+/-20 minutes, p > 0.05). Our results suggest that there is a significant statistical relation between the postoperative shoulder pain levels and increased insufflation rates. For this reason, low insufflation rate significantly reduces the shoulder pain but does not increase the operation time. Therefore, a low insufflation rate should be applied in all cases for patients' comfort and safety.

Intravenous Ketorolac vs Intravenous ProchlorDerazine for the Treatment of Migraine Headachis

Abstract: Objective: To compare IV ketorolac with IV prochlorperazine as the initial treatment of mi- graine headaches in the ED. Methods: A prospective, double-blind comparison study was performed, using a convenience sample of 64 patients suffering from migraine headaches presenting to the ED at a ter- tiary care university teaching hospital. Patients were randomly assigned to receive either 10 mg of pro- chlorperazine IV or 30 mg of ketorolac IV. Patients scored the severity of their headaches using a 10-cm visual analog pain scale. An initial mark was made on the scale at the time of entry into the study and later another mark was made on a new unmarked pain scale 1 hour after medication administration. Changes in pain scores within each treatment group and between groups were analyzed using the Wilcoxon rank sum test. Results: Prior to treatment, the pa- tients assigned to receive prochlorperazine had a me- dian score of 9.2 cm (mean ? SD pain score of 8.3 cm 2 2.1 cm), while the patients receiving ketorolac had a median score of 9.0 (mean pain score of 8.4 cm 2 1.7 cm). There was no significant difference between the pain scores of the participants in the 2 groups prior to treatment (p = 0.80). One hour after medication administration, the patients in the prochlorperazine group had a median score of 0.5 cm (mean 2.1 rf: 3.2 cm), while those patients receiving ketorolac had a median pain score of 3.9 (mean 4.0 t 3.3 cm). The decrease in pain score was significant for both groups of patients (p = 0.0001). The change in pain score for the patients in the prochlorperazine group (median 7.1) was significantly greater than the change in pain score for the patients in the ketorolac group (median 4.0; p = 0.04). Conclusion: Although both drugs were associated with a significant reduction in pain scores, benefit over a placebo agent was not tested. Further- more, the patients who received prochlorperazine IV for migraine headaches had a statistically significant greater decrease in their pain scores than did those receiving ketorolac IV. Key words: headache; mi- graine; ketorolac; prochlorperazine. ACADEMIC EMERGENCY MEDICINE 1998; 5~573-576

Video-assisted Thoracoscopic Excision of Herniated Thoracic Disc: Description of Technique and Preliminary Experience in the First 29 Cases

Abstract: This study evaluates the technique and results of video-assisted thoracoscopic surgery (VATS) for the treatment of symptomatic thoracic disc herniation. Results were compared with a literature review of open surgical techniques of thoracic disc excision with regard to efficacy, safety, and surgical outcomes. VATS has recently been described for thoracic surgery as having the advantage of decreased postoperative pain and morbidity, faster patient recovery, and shortened intensive care unit (ICU) hospitalization. Twenty-nine consecutive patients underwent VATS for symptomatic thoracic disc herniation. Herniations ranging from T5-6 to T12-L1 were successfully approached by using a three- or four-portal strategy. Postoperative magnetic resonance imaging (MRI) scans were evaluated. Pre- and postoperative Oswestry Disability Questionnaires and Linear Analog Pain Scale data were obtained. Patients were grouped according to presenting symptoms. The minimal follow-up was 1 year (range, 12-24 months). Mean operative time was 175 min for 29 patients. Significant improvement (p < 0.01, paired t test) was recorded in Oswestry Disability Questionnaires and Linear Analog Scale Tests. Of the patients, 75.8% (22) were satisfied, 3.4% (one) unsatisfied, with 20.1% (six) unchanged. Narcotic use was significantly eliminated or reduced. Mean return to work was 5 weeks (private insurance) and 21 weeks (workers compensation). The surgical and postoperative complication rate was 13.8%. VATS appears to be a safe and efficacious method of excising herniated thoracic discs. Follow-up results at 1 year resulted in high patient satisfaction. VATS advantages include decreased length of hospitalization as well as improved patient comfort.

Postoperative epidural analgesia for pediatric spine surgery.

Abstract: The safety of epidural infusion for postoperative analgesia in pediatric spine surgery continues to be established. A continuous epidural infusion of morphine sulfate and bupivacaine was used for postoperative analgesia in 12 pediatric patients undergoing spinal surgery. The epidural was placed intraoperatively by the operating surgeon, while continuous infusion was managed postoperatively by a pediatric anesthesiology pain service team. In addition to the continuous infusion, 2 of the 12 also were provided on-demand patient-controlled boluses via epidural catheter for breakthrough pain. Patients experienced analgesia as documented by a comprehensive pain scale form. No catheters failed, while side effects were minimal and easily managed. These results provide confirmation of the safety and efficacy of continuous epidural infusion for postoperative analgesia following pediatric spine surgery and evidence that patient-controlled epidural analgesia is an option.

The prostate anesthetic block for outpatient prostate surgery.

Abstract: With the emergence of minimally invasive techniques for the treatment of benign prostate hyperplasia and the need to reduce health care costs, a simple and effective prostate anesthetic block may allow more procedures to be done in an outpatient or office setting. As based on neuroanatomy studies of the prostate, the perineal approach appeared to be the best way to anesthetize the prostate. This technique was used in 43 patients who underwent interstitial laser coagulation an outpatient or office setting. The perineal prostatic block was effective for pain control whether lidocaine or lidocaine/bupivacaine was used as determined by visual analog scale, linear pain scale, or global pain questionnaire. The use of intravenous (i.v.) sedation did not influence the efficacy of the prostate anesthetic block. Thus, the perineal prostate anesthetic block may be employed in patients undergoing minimally invasive surgery for benign prostatic hyperplasia in the outpatient/office location.

Everyday Pain in Three- to Five-Year-Old Children in Day Care

Abstract: A new event sampling instrument, the Dalhousie Everyday Pain Scale, was used to observe 50 children in six day care centres in Saskatoon for an average of 2.24 h each. The nature of minor painful incidents (eg, collisions and falls) was recorded, including distress behaviours and responses from peers and adults. Twenty-nine children (58%) were observed to experience one or more painful incidents, producing a total of 51 incidents and yielding a median rate of incidents of 0.31 per child per hour, a rate similar to that reported in another Canadian sample. Seven of nine child response items met criteria for reliability in a subsample of incidents observed simultaneously by two observers. Rubbing the affected body part, crying and making verbal statements about the injury were the most common responses to painful incidents. Intervention by day care staff was strongly associated with children's facial expression of distress: physical and first aid interventions were offered most frequently to children who displayed the greatest facial distress. Content analysis of observers' records produced a classification scheme for causes of painful incidents. Twenty per cent of painful incidents were judged to be the result of deliberate actions by other children. The classification of causes may be a useful addition to the scale for application in future studies of everyday pain and injury prevention.

Transnasal butorphanol is effective for postoperative pain relief in children undergoing myringotomy.

Abstract: Background More than 70% of children require analgesics after bilateral myringotomy and tube placement (BMT). Because anesthesia for BMT is generally provided by face mask without placement of an intravenous catheter, an alternative route for analgesia administration is needed. Transnasal butorphanol is effective in relieving postoperative pain in adults and children. The effectiveness of transnasal butorphanol for postoperative pain management in children undergoing BMT was studied. Methods This double-blinded, placebo-controlled study compared the postoperative analgesic effects of transnasal butorphanol administered after the induction of anesthesia. Sixty children classified as American Society of Anesthesiologists physical status 1 or 2 who were aged 6 months or older and scheduled for elective BMT were randomized to receive transnasal placebo or 5, 15, or 25 microg/kg butorphanol. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) on arrival in the postanesthesia care unit and at 5, 10, 15, 30, 45, and 60 min. Results The CHEOP scores were significantly less in the 25 microg/kg transnasal butorphanol group compared with controls. Significantly fewer children received rescue analgesia in the 25 microg/kg transnasal butorphanol group compared with controls (n = 1 and 8, respectively; P = 0.02). Conclusions Transnasal butorphanol given in a dose of 25 microg/kg after induction of anesthesia provided adequate postoperative pain relief in children undergoing BMT.

Does the Use of Topical Lidocaine, Epinephrine, and Tetracaine Solution Provide Sufficient Anesthesia for Laceration Repair?

Abstract: Objective: To determine: 1) the effectiveness of lidocaine, epinephrine, and tetracaine (LET) solution in eliminating or reducing the pain experienced in suturing superficial lacerations in adult patients; and 2) the effectiveness of LET in reducing the pain of local anesthetic injection. Methods: A prospective, randomized, double-blind study in which 60 adult patients with superficial lacerations were entered was conducted in the ED of a community-based teaching hospital affiliated with the University of Toronto. Following application of the LET or placebo (sterile water) solution to the laceration, a visual analog pain scale was recorded by the patient upon needle probing of the wound margin. If probing was painless, the laceration was repaired using LET alone. If injection of local anesthetic was required, an additional pain scale was elicited to quantify the attenuation of the pain of injection by the prior application of LET. Results: Pain scale values on needle probing were significantly reduced in the LET group vs the placebo group (medians of 4.0 vs 5.0 cm, respectively; p < 0.05). Only 13 of the 30 patients in the LET group required additional anesthetic, while all 30 patients in the placebo group requested local anesthetic. Pain scale values on injection of local anesthetic were not significantly different between the LET and placebo groups (medians of 3.5 vs 5.0 cm, respectively; p = 0.09), although there was a trend for lower pain scale values for those patients who received LET. No adverse effects were noted after the application of either LET or placebo solution. Follow-up was achieved for 54 of 60 patients with only 1 complication (a wound infection) reported in the LET group. Conclusions: Significantly fewer patients require an injectable anesthetic when LET is applied. Those who do require an injection may experience less discomfort. These advantages should be balanced against the 20 to 30 minutes necessary for the LET to take effect.

Mammography: influence of departmental practice and women's characteristics on patient satisfaction: comparison of six departments in Norway.

Abstract: OBJECTIVE: To investigate how departmental practice and women's characteristics are related to low patient satisfaction with mammography. DESIGN: Survey of patients by means of self administered questionnaires before and after mammography. PATIENTS: 488 women (89% of those invited), aged 23-86 years, at six departments. MAIN OUTCOME MEASURES: Low level of satisfaction measured on psychometric scales of physical pain, psychological distress, staff punctuality and technical skills, information provided, and physical surroundings. RESULTS: Satisfaction varied by department on the scales for pain, punctuality, information, and surroundings. After adjustment for women's characteristics an attributable risk of negative outcome by department was identified on the scales for pain, distress, punctuality, information, and surroundings. Adjusted odds ratio (ORs) ranged from 0.3 (95% confidence interval (95% CI) 1.2 to 6.0) on the pain scale, to 6.0 (2.9 to 12.3) on the punctuality scale. After adjustment for confounding variables, higher risk of dissatisfaction was associated with age < 50, nervousness about mammography, expected pain, lack of knowledge about mammography, and distrust in mammography (adjusted OR (95% CI) ranged from 1.6 (1.0 to 2.7) to 3.7 (2.0 to 7.3)). CONCLUSION: Departmental practices differed for breast compression, information, punctuality, and facilities and were associated with a low level of satisfaction irrespective of patient characteristics. Women's lack of knowledge about mammography and distrust in the procedure were confirmed as risk factors for dissatisfaction. All these factors might be helped by training the staff, improving facilities, and informing the women.

The effectiveness of a standardized educational program for children using patient-controlled analgesia.

Abstract: purpose. To examine the effectiveness of two types of preoperative education (routine education and a standardized educational program) for children undergoing spinal fusion. design. Two group, phase-lag design. setting. Tertiary pediatric hospital. participants. Children ages 8-18 years (N = 93) main outcome measures. Adolescent Pediatric Pain Tool, Child Pain Scale, Post-PCA Satisfaction Interview, and PCA infusion pump data. results. No statistically significant differences between the groups on any of the main outcome variables. Children and parents reported, however, that the SEP provided them with invaluable information regarding the use of PCA and alleviated their concerns about getting “hooked on drugs,” overdosing, side effects, and being able to get pain relief when needed. conclusion. Children having spine fusion surgery experienced severe postoperative pain that was not ameliorated by optimizing use of PCA through standardized education. Further testing of the SEP with other populations is needed in order to more fully realize its potential for influencing pain outcomes.

Brief Report: Behavioral Correlates of Postoperative Pain in Toddlers and Preschoolers

Abstract: Objective: To investigate the association between preoperatlve parent and child behaviors and postopera-tive pain in toddlers and preschoolers.Method: Participants were 74 pedlatrlc patients (59 boys, IS girls), scheduled for Inguinal hernia or hy-drocele repair, and their parents. Children ranged in age from 12 to 64 months (M = 33.7 months, 5D =14.7 months). Child and parent behaviors were assessed 30 minutes prior to surgery using the BehavioralObservation Scale (BOS), a modified version of the Dyadic Prestressor Interaction Scale (Melamed fit Bush,1985). Postoperative pain was assessed using an observational measure, the Toddler-Preschooler Postopera-tive Pain Scale (TPPPS) (Tarbell, Cohen, & Marsh, 1992).Results: Postoperative pain was negatively related to parents' provision of surgery-relevant information dur-ing the preoperative observation period.Conclusions: Preoperative interventions for young children should include information about the surgery ex-perience.

[Bronchial endoscopy under local anesthesia and pain in children. The value of a nitrous oxide-oxygen combination].

Abstract: To evaluate the efficacy of continuous administration of 50% nitrous oxide in oxygen for reducing pain during flexible fiberoptic bronchoscopy 32 children aged 3-60 months were randomly assigned to an experimental or a control group. Indications for endoscopy included persistent atelectasis (6), wheezing (10) cystic fibrosis (2) pneumonia (11) persistent cough (3). All patients received Midazolam (0.3 mg/kg) atropine (20 mcg/kg) intra rectaly 20 minutes before the procedure. The flexible fiberoptic bronchoscope (Olympus BF3C4) was inserted transnasally through a face mask. Topical anesthesia with 1% lidocaine hydrochloride (3 mg/kg) was applied to the nose, larynx, trachea and bronchial tree over 15 minutes through the suction chanel of the bronchoscope. All patients were monitored with a pulse oximeter and a cardiac monitor. The experimental group (n = 16) received 50% nitrous oxide in oxygen prior (3 minutes) and during flexible fiberoptic bronchoscopy, the control group (n = 16) received only oxygen. We measured pain of the children by a behavioral observation scale (Children's Hospital of Eastern Ontario Pain Scale: CHEOPS) at each phase of topical anesthesia during bronchoscopy in the two groups. At the end of bronchoscopy physician's satisfaction was scored by a visual analogue scale (VAS 0-100) in which 0 corresponded to absence of satisfaction. Nitrous oxide was associated with lesser pain scores than those with oxygen. Physician significantly preferred these procedure compared with oxygen. No complication occurred during procedure. Combined with local anesthesia midazolam and atropin the administration of 50% nitrous oxide in oxygen seems a better choice for flexible fiberoptic bronchoscopy in children and should be used routinely.

Sore throat after use of the laryngeal mask and intubation

Abstract: The laryngeal mask was developed by Brain in 1981 and described for the first time in 1983. It has been applied a few million times worldwide since 1988. One of the main complication is soreness of the throat. Two hundred unselected patients who had gynaecological procedures under general anaesthesia--100 under laryngeal mask airway and 100 under intubation--were surveyed to ascertain the incidence of sore throats under laryngeal mask airway. Each patient was asked about soreness of the throat during the next two days. The incidence and duration of sore throats were recorded using a pain scale (0-100). After narcoses with the laryngeal mask, 63 patients had no complaints. Thirty-seven had sore throats with an average pain score of 8.1 +/- 13.8 on the day of operation. The average pain scores showed a decreasing tendency (4.2 +/- 9.5 and 0.4 +/- 2.6) for the first and second postoperative day. After intubation narcoses, we recorded sore throats significantly more frequently (p < 0.05) and the average pain score on the day of operation was significantly higher (13.2 +/- 17.5; p < 0.05) than after narcoses with the laryngeal mask. Also after narcoses with the laryngeal mask, the average pain scores decreased quickly on the first and second postoperative days (5.1 +/- 9.0 and 0.2 +/- 1.4). There were no differences regarding sore throats between narcoses with the laryngeal mask or intubation on these two postoperative days. Using both anaesthesiological methods, sore throat was not related to duration of anaesthesia or the experience of the anaesthetist.