Acute Pain

Editorial Board

2009-12-01

Announcement

2009-12-01

Premature termination of epidural analgesia—A prospective analysis to improve quality

F. Heid, T. Piepho, S. Stengel, A. Hofmann, J. Jage — 2009-12-01

Summary: Background and objective: Epidural analgesia (EA) is a gold-standard in post-operative pain control. Therefore, modern treatment concepts targeting early patient recovery regularly implement EA. Due to its increasing impact, EA should meet high quality standards in respect to application and maintenance. Though, daily practice often reveals EA-related problems, our investigation aimed to improve EA quality by assessing incidence and reasons of undeliberate, premature termination of post-operative EA.Methods: In the first step all patients with post-operative EA were retrospectively studied covering a 6-month period (group 1). We analysed incidences and reasons of undeliberate termination of EA. Thereafter we modified our treatment protocols (preferential thoracic EA, continuous peripheral blocks, low concentrated local anaesthetic solutions, standardized co-medication). This was followed by a prospective analysis of all EA patients for another 6 months (group 2).Results: 777 patients were included (group 1 n=400, group 2 n=377). Undeliberate termination of post-operative EA was documented in 24.3% of group 1 patients (group 2: 14.1%; p<0.05). In all patients, pain was the leading reason of premature termination (group 1: 52%; group 2: 68%), followed by motor block (group 1: 21%; group 2: 7.5%) and catheter dislocation (group 1: 10%; group 2: 16.7%).Discussion: Modified treatment protocols reduced the rate of premature termination of EA from 24% to 14%. Particularly, we noted less motor impairment but still this rate is disappointing. The increasing rate of catheter dislocations underlines that a continuous analysis of all treatment aspects must be compulsatory.

Anaesthesiologist-associated risk factors for inadequate postoperative pain management

2009-12-01

Summary: Background: Issues associated with the analgesic failure are major contributors to diminished postoperative health quality. The aim of this survey was to investigate the risk factors associated with anaesthesiologists for inadequate postoperative pain management, i.e. ≥3cm in a 10cm gauge of Visual Analog Scale.Methods: A total of 1162 confidential questionnaires were sent by mail to anaesthesiologists in clinical hospitals. Information was queried on the incidence of inadequate postoperative pain management with different length of experience in anaesthesia, reasons for such incidence and possible rescue treatments after the occurrence of the incidence, and knowledge in terms of analgesia protocols. Education background and working settings were requested as the contributing factors.Results: In 813 returned questionnaires, 798 were completed and the data were valid for analysis (68.7% valid response rate). Approximately 43% reported encountered at least one or more incidents of inadequate postoperative analgesia. All positive answers indicated inadequate postoperative analgesia was related to types of surgery. A multiple logistic regression (r2=0.74, P<0.0001) analysis revealed that age, length of anaesthesia experience, education background and work environment are four risk factors in contributing to the incidence. Patient-controlled analgesia is the first choice for postoperative pain therapy, and opioids are preferred as the rescue drugs for inadequate postoperative analgesia.Conclusions: Inadequate postoperative analgesia occurs widely. Age, length of anaesthesia experience, education background and the working environment of anaesthesiologists are risk factors for inadequate postoperative pain control.

Comparison of fentanyl and butorphanol for postoperative pain relief with intravenous patient controlled analgesia

Bhoomika Thakore, Jacqueline D’Mello, Shalini Saksena, Manju Butani — 2009-12-01

Summary: Background: Opioids are very effective as postoperative analgesics, influencing emotional aspects of pain as well as reducing the actual pain threshold. Fentanyl, a phenylpiperidine derivative and potent opioid agonist, has already been studied for postoperative analgesia. Butorphanol, a synthetic morphinan derivative – agonist–antagonist, has few studies to substantiate its use. The present study was undertaken to compare the effects of the two drugs on postoperative pain relief in terms of efficacy and safety.Methods: A prospective, randomized controlled study of 100 patients [ASA I and II] undergoing total abdominal hysterectomies was conducted. Group F of 50 patients received fentanyl [0.4μg/kg/h] and group B received butorphanol [4μg/kg/h] as postoperative pain treatment via intravenous patient controlled analgesia [i.v. PCA]. Parameters monitored were pain score [VAS], pulse, blood pressure, respiratory rate, sedation score and side effects. The infusion rate, number of boluses, PCA demands and requirement of rescue analgesia were noted.Results: Butorphanol had a better maintenance phase than fentanyl. The VAS scores were found to be reduced in the butorphanol group when compared with fentanyl group, significantly at 8h [F: 1.16±1.037; B: 0.78±0.582; p-value: 0.026]. The incidences of complications were comparable in both the groups.Conclusion: Both the drugs are equally effective and safe as postoperative analgesics with i.v. PCA. The dose of 4μg/kg/h of butorphanol appeared effective but the dosage of fentanyl used, 0.4μg/kg/h, was not as effective as evidenced by the increased number of boluses taken by patients and needs to be increased.

Electrical punctual stimulation (P-STIM) with ear acupuncture following tonsillectomy, a randomised, controlled pilot study

H. Kager, R. Likar, H. Jabarzadeh, R. Sittl, C. Breschan, J. Szeles — 2009-12-01

Summary: Background: We examined whether P-STIM, administered pre- and postoperatively after tonsillectomies, resulted in a lower consumption of analgesics and an improvement of pain scores compared to sham acupuncture.Methods: This study was carried out in a randomised, double-blind, controlled fashion. Thirty-three patients were randomised into 2 groups. All patients had P-STIM applied to them beginning 30min preoperatively. The stimulation was applied over the following 96h. The P-STIM-Verum group received sub-threshold stimulation. No stimulation was applied in the P-STIM-Placebo group.Premedication and anaesthesia were applied in a standardised fashion. The efficacy of P-STIM application was evaluated postoperatively using numeric and visual analogue scales at rest and with exertion and by measuring postoperative analgesic consumption.Results: At almost all the measured time points the median pain score was less in the P-STIM-Verum group than in the P-STIM-Placebo group. The VAS scores at rest and with exertion were also significantly less in the P-STIM-Verum group at certain time points. Analgesic consumption in the P-STIM-Verum group was also less than in the P-STIM-Placebo group; however the difference did not reach statistical significance.Conclusions: We were able to demonstrate in our study, that P-STIM applied pre- and postoperatively following tonsillectomies, is a simple method that seems to be effective and has few side-effects.

Postoperative opioid usage in children receiving Remifentanil vs. sufentanil

Tara M. Doherty, Terri Voepel-Lewis, Robert E. Christensen, Shobha Malviya — 2009-12-01

Summary: Background: Studies have found a 30–50% increase in postoperative opioid demand following intraoperative use of remifentanil infusion, suggesting development of acute opioid tolerance. This study was undertaken to compare postoperative opioid requirements in children who received remifentanil versus sufentanil infusions during spine fusion.Methods: A secondary review of data from children 8–18 years of age, who had undergone spine fusion was conducted. Patients who had received remifentanil infusions were matched by age, procedure, and duration of anaesthesia to those who received sufentanil infusions. Data included patient demographics, total intraoperative and postoperative opioids, and self-reported pain scores. Postoperative pain was managed with morphine patient controlled analgesia, and acetaminophen and diazepam as needed.Results: Forty-four children (13.5±3 years) were included. Demographic and procedural data were similar between groups. There were no differences between remifentanil or sufentanil groups in high pain scores (5.3±2.4 vs. 5.7±2.6, respectively) or cumulative morphine requirements (1.02±0.32mg/kg vs. 1.07±0.48mg/kg) during the first 24h after surgery.Conclusion: This study found no difference in opioid consumption between children who received remifentanil versus sufentanil infusions. Findings suggest that these short-acting potent opioids similarly affect morphine requirements following spine fusion.

Effects of cognitive pain coping strategies and locus of control on perception of cold pressor pain in healthy individuals: Experimental study

Natasa Jokic-Begic, Dragutin Ivanec, Dragana Markanovic — 2009-12-01

Summary: Background: The aim of the present study was to determine the effectiveness of the coping strategies – distraction and redefining – on pain experience in individuals with internal vs. external locus of control.Method: The participants were exposed to pain induced by cold pressor procedure. Pain tolerance, pain intensity, and objective and subjective duration of pain were measured in three different situations. In the control situation, the participants did not use any cognitive pain coping strategy. In two other situations, they used distraction and redefining strategies, respectively.Results: Internally- and externally-oriented participants did not differ in pain tolerance, pain intensity ratings, and subjective duration of painful stimulation in any of the three situations. The use of cognitive pain coping strategies increased pain tolerance in both groups in comparison with the control situation. In both situations, the participants underestimated the duration of pain tolerance. There was no difference between the effectiveness of distraction and redefining strategies on pain tolerance and pain intensity ratings.Conclusion: Cognitive pain coping strategies increase the duration of pain tolerance irrespective of the individual's locus of control, but have no effect on pain intensity rating.

Contralateral limb movement modulates cold pressor pain

Eric E. Brodie, Fiona M.A. Kane, Karel Gijsbers, Catherine A. Niven — 2009-12-01

Summary: Background: Many studies investigating the attenuation of pain by psychological means have confounded cognitive factors with motoric factors. Two experiments were performed to investigate the extent to which intentional movements alone can attenuate experimental pain.Methods: In experiment 1, tolerance and intensity of cold pressor pain administered to the non-dominant hand was measured for two movement conditions, reciprocal eye movements and reciprocal finger movements of the dominant hand. In experiment 2, tolerance and intensity was measured for two reciprocal finger movement conditions, when visual attention was directed to the dominant hand and when visual attention was directed to the location of the noxiously stimulated non-dominant hand.Results: Reciprocal finger movements of the limb contralateral to a noxiously stimulated limb were found to result in significantly longer tolerance times and significantly lower pain intensity ratings when visual attention was directed to and away from the spatial location of the noxious stimulation.Conclusion: These results confirm that movement of the limb contralateral to a noxiously stimulated limb attenuates experimental pain. Further research is required to ascertain whether movement alone attenuates non-experimental pain.

In search of an ideal analgesic for common acute pain

Nicholas D. Moore — 2009-12-01

Summary: The choice of an oral analgesic is an important determinant in achieving effective pain relief. Properties of an ‘ideal analgesic’ required for the management of acute pain are discussed and current evidence for the suitability of available analgesics – acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen), opioids and combination therapy – is reviewed. The hypothesis that an ‘ideal analgesic’ for acute pain should have a rapid onset of action, act over an extended period of time, reduce awareness of pain quickly and minimise interruption by pain, be well tolerated and produce analgesia over a wide range of pain types in different patient populations, is proposed herein. Currently available analgesics may fulfil only some of these characteristics and, because individual patient response also varies, the challenge is to define what constitutes an acceptable analgesic for a specific patient or pain type.Various tools for measurement of each of these characteristics exist, but there is currently no single measure to determine the ‘ideal analgesic’ for a specific patient with a specific pain type that takes into account all the characteristics of an ‘ideal analgesic’ and provides an overall measure to quantify the quality of relief produced.

Phantom limb like pain and sensations in an intact lower extremity

Suparna Saha, Eldor L. Brish, Krishna Boddu — 2009-12-01

Summary: Phantom limb pain is defined as pain localised in a body part that is no longer there (Mishra et al. ; Flor et al. ; Mayo Clinic Staff ). It is believed that amputation of an extremity is required for phantom pain and sensations to occur (Nikolajsen and Jensen ). However, we report a case in which a severed nerve to an “intact extremity” resulted in phantom limb-like pains and sensations which responded to a treatment regimen identical to that for phantom limb pain. It is important for clinicians to entertain the idea of phantom limb-like pain in cases when a nerve is severed to any extremity and as such, provide pain relief to this subgroup of patients.

Continuing use of droperidol in patient-controlled analgesia with morphine

C.M. Ball, P. Claydon — 2009-12-01

Intravenous patient-controlled analgesia (PCA) with morphine is commonly used after major surgery. Nausea and vomiting are frequent adverse effects, but the incidence can be reduced by using prophylactic antiemetics.

Bacterial contamination of PCA and epidural infusion devices

M. Rothwell, D. Pearson, K. Wright, D. Barlow — 2009-12-01

We prospectively audited the bacterial contamination of re-usable analgesia infusion pumps. In a 1-month period, 112 samples from the handset and keypads of our analgesia infusion pumps were cultured for bacterial contamination. Forty-five percent of handset swabs and 46% of keypad swabs grew bacteria; the commonest organism being coagulase-negative staphylococcus. An additional cleaning step using 70% isopropyl alcohol wipes was introduced and the contamination rate was re-audited in 100 samples. The contamination rate was reduced to 6% of handset swabs and 4% of keypad swabs. A high initial rate of bacterial contamination of re-usable analgesia infusion pumps was significantly reduced by the implementation of a simple, additional cleaning procedure.

Multimodal analgesia for controlling acute postoperative pain

A. Buvanendran, K.S. Kroin — 2009-12-01

Purpose of review: Multimodal analgesia is needed for acute postoperative pain management due to adverse effects of opioid analgesics, which can impede recovery; a problem that is of increasing concern with the rapid increase in the number of ambulatory surgeries. Yet, the literature on multimodal analgesia often shows variable degrees of success, even with studies utilizing the same adjuvant medication.

Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes

E.M. Pogatzki-Zahn, J.S. Englbrecht, S.A. Schug — 2009-12-01

Purpose of review: Patients with fibromyalgia are at increased risk to experience increased and prolonged postoperative pain. In this review, we will provide an overview of pathophysiological characteristics of fibromyalgia relevant for enhanced pain processing after surgery. Furthermore, we will present some potential treatment options in the perioperative period based on specific symptoms of individual fibromyalgia patients to optimize their pain management after surgery.

Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty

H. Clarke, S. Pereira, D. Kennedy, I. Gilron, J. Katz, J. Gollish, J. Kay — 2009-12-01

Background: Moderate to severe pain after total knee arthroplasty often interferes with postoperative rehabilitation and delays discharge from hospital. The present study examined the effects of a 4-day postoperative gabapentin (GBP) regimen versus placebo on opioid consumption, pain scores and knee flexion, as well as adverse effects, after total knee arthroplasty.

Predictive factors of postoperative pain after day-case surgery

2009-12-01

Objectives: Despite the growing number of ambulatory operations knowledge of predictive factors of postoperative pain after ambulatory surgery is limited. Therefore, the aim of this study was to identify predictive factors of postoperative pain after ambulatory surgery.

The analgesic properties of scalp infiltrations with ropivacaine after intracranial tumoral resection

H. Batoz, O. Verdonck, C. Pellerin, G. Roux, P. Maurette — 2009-12-01

Background: The issue of postoperative pain after neurosurgery is controversial. It has been reported as mild to moderate and its treatment may be inadequate. Infiltration of the surgical site with local anesthetics has provided transient benefit after craniotomy, but its effect on chronic pain has not been evaluated. Accordingly, we designed the present study to test the hypothesis that ropivacaine infiltration of the scalp reduces acute and persistent postoperative pain after intracranial tumor resection.

Randomised clinical trial of the influence of local subcutaneous infiltration versus subcutaneous and deep infiltration of local anaesthetic on pain after appendicectomy

J.K. Randall, A. Goede, P. Morgan-Warren, S.B. Middleton — 2009-12-01

Introduction: Local anaesthesia is commonly used to provide pain relief after surgery. The aim of this randomised, blinded prospective trial was to evaluate whether local subcutaneous and deep infiltration of local anaesthetic provides better post-operative pain control than subcutaneous infiltration alone.

Randomized double-blind placebo controlled crossover study of acetaminophen, ibuprofen, acetaminophen/hydrocodone, and placebo for the relief of pain from a standard painful stimulus

J.R. Miner — 2009-12-01

Objectives: The objective was to compare subjects’ change in perceived acute pain from an identical painful stimulus after receiving three separate, commonly used pain medications and placebo.

New and emerging analgesics and analgesic technologies for acute pain management

J.W. Heitz, T.A. Witkowski, E.R. Viscusi — 2009-12-01

Purpose of review: Recent advances in drug delivery technology have provided new means of delivering medications with improved efficacy and safety. This review details developments in drug delivery recently made available or in development with the potential to better deliver analgesia.

Two milligrams i.v. hydromorphone is efficacious for treating pain but is associated with oxygen desaturation

A.K. Chang, P.E. Bijur, A. Napolitano, J. Lupow, E.J. Gallagher — 2009-12-01

Objective: To evaluate the safety and efficacy of a single dose of 2mg i.v. hydromorphone administered to emergency department patients in acute severe pain. Design: Prospective interventional.

No evidence for generalized increased postoperative responsiveness to pain: A combined behavioral and serial functional magnetic resonance imaging study

2009-12-01

Background: Although it is generally accepted that increased pain responsiveness and central sensitization develop after major tissue injury, this claim has not been tested using brain imaging methods in a clinical pain setting. We tested this hypothesis using a postoperative pain model, in conjunction with serial functional magnetic resonance imaging (fMRI).

Mu-opioid receptor (A118G) single-nucleotide polymorphism affects alfentanil requirements for extracorporeal shock wave lithotripsy: A pharmacokinetic–pharmacodynamic study

Y. Ginosar, E.M. Davidson, Y. Meroz, S. Blotnick, M. Shacham, Y. Caraco — 2009-12-01

Background: There are diverse reports concerning the single-nucleotide polymorphism (SNP) A118G in the gene coding for the mu-opioid receptor. This study assessed pharmacokinetic–pharmacodynamic relationships in patients with acute pain (water-immersed extracorporeal shock wave lithotripsy).

Does the presence of psychosocial “yellow flags” alter patient–provider communication for work-related, acute low back pain?

W.S. Shaw, G. Pransky, T. Winters, T.H. Tveito, S.M. Larson, D.L. Roter — 2009-12-01

Objective: To determine whether patterns of patient–provider communication might vary depending on psychosocial risk factors for back disability. Methods: Working adults (N=97; 64% men; median age=38 years) with work-related low back pain completed a risk factor questionnaire and then agreed to have provider visits audiotaped. Verbal exchanges were divided into utterances and coded for content, then compared among low-, medium-, and high-risk patients.

Acute pain and availability of analgesia in the prehospital emergency setting in Italy: A problem to be solved

2009-12-01

Objectives: The treatment of acute pain in the prehospital emergency setting remains a significant problem. We evaluated the incidence, site, and possible cause of acute pain in the prehospital period and also the current state of prehospital pain management by evaluating analgesic availability in emergency vehicles in Italy.

A multicenter, open-label, exploratory dose-ranging trial of intranasal hydromorphone for managing acute pain from traumatic injury

D.P. Wermeling, T. Clinch, A.C. Rudy, D. Dreitlein, S. Suner, P.G. Lacouture — 2009-12-01

We conducted a prospective multicenter, open-label, escalating dose-range trial to compare, across patients, single intranasal doses (2, 4, 6, 8, and 10mg) of hydromorphone HCl in the treatment of acute trauma pain The main outcome measure of pain-intensity reduction was derived from serial Numerical Pain-Rating Scores and calculated as the summed pain-intensity difference over 3h (SPID 3). Nasal examinations, vital signs, and adverse events were reported as safety outcomes. The mean decrease in pain intensity from baseline to 30min was 39–44% for the 4-, 6-, 8- and 10-mg doses (n=19, 33, 28, and 19 per group) and only 24% reduction for the 2-mg dose (n=14). SPID 3 for the 2-mg dose was 40–50% below all other doses. There were no clinically meaningful changes in vital signs or nasal examinations. Adverse events (nausea, vomiting, pruritis, oxygen desaturation, bad taste, dizziness) were of mild to moderate intensity, increased with dose, and expected, based on route of administration and opioid pharmacology. Intranasal hydromorphone provides a component of rapid pain relief in the care of emergency department patients suffering from acute trauma pain.

Acute pain assessment and pharmacological management practices for the older adult with a hip fracture: Review of ED trends

K. Herr, M. Titler — 2009-12-01

Introduction: This article examines acute pain assessment and pharmacological management in the emergency department that occurred over a period of time after the release of the new pain assessment and management compliance standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for accredited health care organizations. Data were available from that collected for a large-scale study testing a Translating Research into Practice intervention to promote use of evidence-based practices for acute pain management in older adults.

Randomized clinical trial comparing a patient-driven titration protocol of intravenous hydromorphone with traditional physician-driven management of emergency department patients with acute severe pain

A.K. Chang, P.E. Bijur, M. Davitt, E.J. Gallagher — 2009-12-01

Study objective: We test the null hypothesis that the “1+1” hydromorphone patient-driven protocol is clinically and statistically equivalent in safety and efficacy to that of traditional physician-driven administration of opioids for emergency department (ED) treatment of acute severe pain.

Medical students retain pain assessment and management skills long after an experiential curriculum: A controlled study

D.L. Stevens, D. King, R. Laponis, K. Hanley, S. Zabar, A.L. Kalet, C. Gillespie — 2009-12-01

We implemented a pain assessment and management (PAM) curriculum for second year medical students and evaluated long-term skills retention compared to the prior year's class which did not receive the curriculum. The curriculum included pain pathophysiology, assessment and treatment instruction plus feedback on PAM practice with standardized patients. Both cohorts underwent a required end-of-third-year clinical skills examination. Intervention and control group performance on three pain cases (acute, chronic and terminal) was compared. The PAM curriculum was implemented 1.5 years before the intervention cohort participated in the clinical skills exam. More intervention students (134/159, 84.3% response rate) obtained basic (87.2% vs. 76.0%, p=.028) and comprehensive (75.2% vs. 60.9%, p=.051) descriptions of acute pain than control students (n=129/174, 74.1% response rate). Intervention students demonstrated superior skills for terminal pain, including: more often asking about impact on functioning (40.7% vs. 25.8%, p=.027), advising change of medication (97.3% vs. 38.7%, p<.001), and providing additional medication counseling (55.0% vs. 27.0%, p<.001). Virtually all students obtained basic descriptions of chronic (intervention vs. control, 98.1% vs. 96.1%, p=.367) and terminal (92.9% vs. 91.7%, p=.736) pain. Surprisingly, more control than intervention students obtained a comprehensive description of chronic pain (94.6% vs. 77.8%, p<.001) and asked about current pain medication in the terminal case (75.6% vs. 55.0%, p=.004). Exposure to the curriculum resulted in durable increases in students’ ability to perform PAM skills in patients with acute and terminal pain.

Measuring acute pain in the prehospital setting

P.A. Jennings, P. Cameron, S. Bernard — 2009-12-01

Severe pain is a common presenting symptom for emergency patients. One major challenge in the management of severe pain is the objective measurement of pain. Due to the subjective nature of pain, it can be very difficult for clinicians to quantify pain intensity and measure the qualitative features of the pain experience. A number of measurement tools have been validated in the acute care setting, with some appropriate for use in the prehospital setting. This paper reviews the characteristics required of a prehospital acute pain measure and appraises the relative utility of a number of currently used pain measures. At present, the verbal numerical rating scale appears the most appropriate pain measure to administer in the prehospital setting for adult patients as it is practical and valid. Either the Oucher scale or the faces pain scale is suitable for prehospital care providers to assess pain in children.

Monitoring electrical skin conductance: A tool for the assessment of postoperative pain in children?

B. Hullett, N. Chambers, J. Preuss, I. Zamudio, J. Lange, E. Pascoe, T. Ledowski — 2009-12-01

Background: Monitoring changes in electrical skin conductance has been described as a potentially useful tool for the detection of acute pain in adults. The aim of this study was to test the method in pediatric patients.

Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: A randomized clinical trial

J.H. Friday, J.T. Kanegaye, I. McCaslin, A. Zheng, J.R. Harley — 2009-12-01

Objectives: This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting.

Managing pain using heat and cold therapy

E. Lane, T. Latham — 2009-12-01

Evidence supports the use of superficial heating and cooling of tissues to provide pain relief in low to moderate levels of acute and chronic pain in adults, but there are no standards or guidelines in children's centres across the UK for administering these modalities in children, so a project was undertaken to develop these locally. Evidence from the literature was used to identify best practice in relation to equipment, safety and infection control. Implementation was supported by educational input and a detailed protocol for assessment and application of the devices. Three years after their introduction a review of the guidelines and an audit demonstrated that these modalities have been beneficial, providing cost-effective, holistic care for children experiencing pain in hospital.

Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: A randomized controlled trial

J.S. Furyk, W.J. Grabowski, L.H. Black — 2009-12-01

Objective: To compare the efficacy of nebulized fentanyl (NF) with i.v. morphine (IVM) in paediatric patients presenting to the ED with clinically suspected limb fractures. Methods: A convenience sample of patients aged 4–13 years, presenting with clinically suspected limb fractures, were randomized to receive either NF at 4μg/kg or IVM at 0.1mg/kg. Pain scores were assessed at 0, 15 and 30min using the Wong and Baker faces pain scale (0–10). Vital signs and adverse effects were also recorded.

Retraction Notice

2009-12-01

Conference Calendar

2009-12-01