The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149726/1/pan13639_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149726/2/pan13639.pd

Perceived language proficiency and pain assessment by registered and student nurses in native English-speaking and EAL children aged 4-7 years

Aims and Objectives To identify the factors that influence decisions made by health professionals when assessing the pain of native English speaking and children whose English is an Additional Language (EAL). Background Pain assessment in children is often poorly executed following acute injury. Whilst a range of pain assessment tools have been developed, little guidance is provided for assessing pain in EAL. Design Factorial survey design. Methods Twenty Minor Injuries Unit (MIU) nurses and twenty children’s nursing students participated in an electronic survey to make judgments on 12 scenarios describing a child attending a MIU following an incident, accompanied by a parent. Respondents had to decide the most important form of pain assessment, and whether they would ask a parent or an interpreter to assess the pain of the child. An open-ended question asked about the difficulties found in making a judgment. Results Observation of the child’s behaviour was the most common pain assessment reported. The Visual Analogue Scale was significantly associated with children with proficient English. Respondents were significantly more likely to involve parents in the assessment if they could speak English well compared to parents with poor English skills. Moreover, nursing students were significantly more likely than registered nurses to call for support from an interpreter. Thematic analysis identified three themes related to difficulties with pain assessment: contrasting approaches, differing perceptions of pain, and overcoming challenges. Conclusions The reduced ability to communicate between child, parent and healthcare professional highlights the need to identify forms of assessment based on individual cases. Relevance to clinical practice The number of children with EAL has seen a marked rise over the last decade. In situations where communication ability is reduced, assessment of pain should tailored to meet the needs of the child. This may require timely access to interpreter services

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice