>I am interested in obtaining any references on pain management in the
>pediatric population, primarily in the emergency department setting.
Steve Selbst has written several papers, cited below...
1. Selbst, S.M., Analgesia in children. Why is it underused in
emergency departments? Drug-Saf, 1992. 7(1): p. 8-13.
2. Selbst, S.M. and M. Clark, Analgesic use in the emergency
department. Ann-Emerg-Med, 1990. 19(9): p. 1010-3.
The relief of pain is one of the most common reasons for seeking
care in an emergency department. We conducted a retrospective chart review
to see whether children received analgesic treatment similar to that of
adults with the same acute, painful conditions. Charts of 112 pediatric
patients from the Children's Hospital of Philadelphia ED and 156 patients
from the Medical College of Pennsylvania ED were reviewed. Patient ages
ranged from a few months to 97 years. All patients had acute pain due to
sickle cell crises (20%), lower-extremity fractures (31%), or second- or
third-degree burns (49%). Hospitalization was required in 15% of cases. In
the ED, 60% of patients with painful conditions received no pain medication
at all. When medications were given, they were usually narcotics. Children
(aged 19 years or younger) were much less likely to receive pain
medications than adults (P = .001). Those less than 2 years old received
analgesics less often than older children (P less than .01). Senior
citizens (aged 65 years or older) received analgesics as often as other
adults. On discharge from the ED, 55% of all patients had no pain
medications prescribed; and children were less likely than adults to
receive analgesics at discharge (P less than .001). Pediatricians and
emergency physicians are reluctant to use analgesics for children in pain.
The data suggest that these physicians need additional education about
management of acute pain.
3. Selbst, S.M. and F.M. Henretig, The treatment of pain in the
emergency department. Pediatr-Clin-North-Am, 1989. 36(4): p. 965-78 issn:
Our approach to the management of fear and pain in the pediatric
emergency department is presented. Tricks to attempt the gaining of rapport
with frightened children in pain are noted, with emphasis on a
developmental approach. The use of analgesic medications, local
anesthetics, ketamine, and nitrous oxide as appropriate to emergency
situations is outlined. Lastly, the guidelines of the American Academy of
Pediatrics for outpatient sedation are reviewed.
4. Selbst, S.M., Managing pain in the pediatric emergency department
[see comments]. Pediatr-Emerg-Care, 1989. 5(1): p. 56-63.
In summary, it is common to encounter children in pain in the
pediatric ED. It is often impossible to avoid inflicting pain on some
children in the ED. The proper management of this pain is thus essential.
This management should be accomplished with a variety of narcotic and
nonnarcotic analgesics, as well as local and topical anesthetics. Other
agents such as nitrous oxide, and techniques such as hypnosis and
transcutaneous nerve stimulation, have a more limited role in pain
management. Gentle restraint and reassurance are of paramount importance.