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Thoracic Surgery Treatment of postoperative pain in children in Madrid

We talked about why we painful stimuli. We given an overview of the different scales measuring pain . Come now to the heart of the matter: how to treat postoperative pain in children? The review that I prepared this week tells you here. Enjoy!

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FOB

has begun the registration period of a new edition of the Course of optical devices in Anaesthesia, Critical Care and Emergency. Be held next November in the Hospital La Paz in Madrid. This year has practical content increased to over 65% of the total course in the form of clinical cases in the operating room (in person and via videoconference) and high-quality simulators. This course is extended to all the techniques of airway control that require optical devices for execution: fibroscopy videolaringoscopia flexible and the presence of subject matter experts to establish guidelines for action to resolve the most common situations and more complex as we face in our daily activities.

I did two years ago (with a broken leg) and I recommend it. The link is this .

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Course Measurement of pain in children

The nervous system of the newborn, including prematurity, is fully developed to receive, conduct, process and perceive painful stimuli to the same extent that an older child or adulto.Los basic mechanisms are similar, however, due to the neurophysiological and cognitive immaturity, there are some differences: for example, the pain impulse transmission occurs primarily in infants along unmyelinated C-fibers rather than A-delta fibers. There is less precision in the transmission of pain signal in the spinal cord and descending inhibitory neurotransmitter lacking. Consequently, infants may perceive pain more intensely than older children or adults, because their mechanisms are immature control downstream. In addition, the neonatal nervous system has higher concentrations (and diffuse) of substance P receptor sites, which limits their ability to modulate the pain experience. Therefore, although unable to speak and responses to pain are more nonspecific, we must start from the premise that any painful situation for the adult, also for the child. Moreover, when the latter can not be drawn against an adaptive response to painful stimuli and receives more anxiety as an adult. Pain is a complex psychological experience, which often cognitive and affective mechanisms are as important as tissue injury. The psychological factor is a determining factor in any assessment of pain.

Measuring pain in children is the subject of ongoing studies and comparisons. Apply many methods of evaluation. Some are subjective by scales which are dominated facial images reminiscent moods or colors or numerical scales (from a certain age.) Other times, they appreciate and quantify the external signs active behavior (crying, facial expression, movement, restlessness) or passive (decay, loss of appetite). Alterations of physiological parameters (respiration, heart rate, hormone levels) are more amenable to modification by other independent causes of pain.

been shown to measure pain is not an experience impossible. As a subjective variable, pain should be quantified by the patient, but as we shall see, in childhood this is impractical in many cases, so you need to develop reliable methods of valuation. Pain assessment must be consistent with the child's developmental stage, severity and chronicity of illness, medical or surgical procedure and the environment.

Assessment is the cornerstone of pain management. When it is evaluated with certainty, there is a "point of principle" well defined to determine the nature and degree of pain and evaluating the effectiveness of interventions to alleviate it.

To this end, two types of methods: self-and hetero.

self methods

Because pain is a subjective experience, self-assessment methods are the "gold standard" to measure. From 18 months of age, children incorporate into their vocabulary words to name the painful sensation. After three or four years, the development of the brain is sufficient to communicate the degree of pain (high or low). Therefore, these methods are generally used in children over three years.

Color Scale

consists of a rule, which goes from white to pink to bright red, almost black, up gradation of minimum to maximum pain pain. The patient indicates, according to the intensity of color, where your pain. Obviously, it is used in children over 5 years.

One of the methods used in chronic pain consultations are the color profiles. It gives the child a tracing, front and back and is asked to paint with colors your pain. Although there are exceptions, children often choose red, purple or black in the areas of maximum pain. The use of serial drawings to evaluate the development of pain.

faces Scale

is composed of a series of 5-6 faces expressing a different intensity of pain (from none to much). Asks the child to choose the face corresponding to their pain. Very young children tend to choose the ends, so it is recommended to use after three years. Scale

visual analogue (VAS)

consists of a template, whose numbers from 0 to 10 are representative of the intensity of pain. Can be used for children 6 and older. Has, as variation in the temperature scale (same, but vertical, color and shape of a thermometer).

hetero methods There

scales used to assess the body's response to pain. These scales are obviously reserved for those children who can not express their pain or in addition to the above. In this case, the assessor who, on a number of physiologically objective parameters, gives a numerical value.

behavior measures can be categorized into descriptions of behaviors per minute, conduct social or related to appetite and changes in the status and cognitive function. Facial action and cry acoustic characteristics are examples of very detailed descriptions of behaviors per minute. Although there appears to be a cry of pain absolutely identifiable characteristics that would identify a painful condition is a high-pitched cry, rough and intense.

facial expression has been the most widely studied of the behavioral assessment measures in pain. Is the indicator more reliable and consistent pain in all populations and as such should be considered the "gold standard" of behavioral responses to pain in children. Facial expressions of infants who experience acute pain include the following features: eyes tightly closed, brows, nostrils large and bulky, deep philtrum, square-shaped mouth and tongue tense and concave.

This, coupled with a series of physiological variables, make up the majority of the scales heteroevaluativas. One is the CRIES (Crying Requires O2, vital signs Increassed expression, Sleppless), I put below:

A very interesting article regarding the measurement of pain is " Validity and reliability of the Behavioural Observational Pain Scale for postoperative pain Measurement in Children 1-7 years of age " which appeared in the journal Pediatric Critical Care Medicine, in 2007, which examines the behavioral and physiological variables that can lead to an objective assessment of pain in children 1 to 7 years. You can download it here .

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Bases anatomical and physiological pain Resources

Nobel Laureate Albert Schweitzer called it "the most terrible of the lords of humankind." Joins us from the biblical "give birth in pain" with which God punished Eve, until now, has been a fellow-sufferer of man wherever he goes. Pain, defined by the IASP as "an unpleasant sensory and emotional experience associated with actual tissue damage, potential or described as such" is the third leg of the specialty of Anesthesiology, Reanimation and Pain Therapy. It is we, who are dedicated to the inexact science of anesthesia, experts in the treatment of this terrible master. Always keeping note that, to treat pain, we should not honor the Greek translation of the word anesthesia: numbness. And the pain is, as stated by the IASP, a subjective aspect that can not be downplayed.

In children, the pain is under treated for many years for several reasons. First, training in pain was low (still is, although this is slowly changing) and, secondly, the choice of opioid was afraid of possible side effects. In addition, there was a social tendency to minimize pain considering it a sign of weakness of character and avoided in children if, big mistake, that did not remember painful episode.

For all that, to put my bit in the knowledge of this third leg of the specialty, I dived full (after the lapse of summer, where the dwarves have left me no breathing) in a full review postoperative pain management in children.

But as the house is to start with the foundation, I have broken the topic into a series of revisions: Today is the first. Let's talk about the anatomical and physiological bases of pain. You can download the patch by clicking here .