Dr. Thornton,

Allow me to piggy back on Jamil's post from SoCal. I would direct you to the original literature that discusses the consequences of untreated pain in the neonatal population. There is some very elegant work by Dr.'s Sunny Anand from AK and Ann Taddio in Canada (related to immunization pain), who have demonstrated that use of topical analgesia or 25% sucrose has significant impact on the emotional response to subsequent painful interventions. In the older child it clearly causes greater anxiety, distress and needle phobia during subsequent health care interactions.

I have no sense for your geographic location, practice setting or specialty. However, most of the procedures I perform are usually around "2 minutes" long! Whether I am manipulating a fracture-dislocation or performing an IND of an abscess, the most painful part rarely lasts more than a few minutes. 

If you as a parent were given the option, would you opt for "brutane" for 2 minutes or PSA in an otherwise healthy child? I would humbly suggest that the reason why "those of us who experienced painful/normal procedures/experiences haven't grown up with any particular psyche disorders" is because we were NEVER given an option by our often patronizing "family" physician! 

The science of pediatric PSA has advanced in leaps and bounds over the last decade and we now have a better understanding of ways to measure and treat pain. It's just the RIGHT thing to do. 


 Jay Pershad
Le Bonheur Children's Medical Center

From: Fergus Thornton <[log in to unmask]>

I'm not sure pain has much to do with this.  What bothers the baby is being held down and doubled up to expose the back.  Not only would I not use PS (risk vs benefit) but I don't use local.  If held well, the procedure is over in one to two minutes or less.  I think the pendulum has swung too far to the "be nice" extreme. It's time to recognize that those of us who experienced painful/normal procedures/experiences haven't grown up with any particular psyche disorders. I use PS to enable me to care for  people, not to protect them from a 2 minute painful procedure. [BTW, the "holder" is much more important than the "needler" in an LP; done well, it shouldn't take more than a minute.] 


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