The Effectiveness of Analgesics in Pain Treatment in Critically Ill Children: a Literature Review
Main Article Content
Keywords
analgesic, opoid, non-opioid, pain measurement, PICU
Abstract
Adequate pain management is an important and common requirement in health care in pediatric intensive care units. There are many pain assessment scales in children based on the literature, but the guidelines for using pain scales as a guide in pain management have not been widely discussed. One of the most common pain interventions is to provide opioid or non-opioid analgesics. Analgesic drugs given to critically ill children can provide different anti-pain outcomes when measured by a pain scale. Therefore, this literature review will compare the effectiveness of analgesics in pain management in critically ill children.
References
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3. LaFond CM, Hanrahan KS, Pierce NL, Perkhounkova Y, Laures EL, McCarthy AM. Pain in the Pediatric Intensive Care Unit: How and What Are We Doing? American Journal of Critical Care. 2019;28(4):265–73.
4. Treede R-D. The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep. 2018;3(2):e643.
5. Yudiyanta NK, Novitasari RW. Penilaian Nyeri. Jurnal Kesehatan. 2015;42(3).
6. van Dijk M, Peters JWB, van Deventer P, Tibboel DM. The COMFORT Behavior Scale. American Journal of Nursing. 2005;105(1):33–6.
7. Sehgal N, Colson J, Smith HS. Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy. Expert Rev Neurother. 2013;13(11):1201–20.
8. Misiołek H, Cettler M, Woroń J, Wordliczek J, Dobrogowski J, Mayzner-Zawadzka E. Zalecenia postępowania w bólu pooperacyjnym — 2014. Anestezjol Intens Ter. 2014;46(4):221–44.
9. Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain. 2006;125(1):143–57.
10. Bailey B, Daoust R, Doyon-Trottier E, Dauphin-Pierre S, Gravel J. Validation and properties of the verbal numeric scale in children with acute pain. Pain. 2010;149(2):216–21.
11. Joestlein L. Pain, Pain, Go Away! Evidence-Based Review of Developmentally Appropriate Pain Assessment for Children in a Postoperative Setting. Orthopaedic Nursing. 2015;34(5):252–9.
12. Dorfman TL, Sumamo Schellenberg E, Rempel GR, Scott SD, Hartling L. An evaluation of instruments for scoring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in pediatric mechanically ventilated patients: A systematic review. Int J Nurs Stud. 2014;51(4):654–76.
13. Marques B, JM C, MJ S. Postoperative Pain Assessment Methods for Infants and Young Children: A Review. Journal of Clinical Research in Pain and Anaesthesia. 2019;1(1):180004.
14. Laures E, LaFond C, Hanrahan K, Pierce N, Min H, McCarthy AM. Pain Assessment Practices in the Pediatric Intensive Care Unit. J Pediatr Nurs. 2019;48:55–62.
15. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain Assessment in the Patient Unable to Self-Report: Position Statement with Clinical Practice Recommendations. Pain Management Nursing. 2011;12(4):230–50.
16. Harris J, Ramelet A-S, van Dijk M, Pokorna P, Wielenga J, Tume L, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med. 2016;42(6):972–86.
17. Playfor S, Jenkins I, Boyles C, Choonara I, Davies G, Haywood T, et al. Consensus guidelines on sedation and analgesia in critically ill children. Intensive Care Med. 2006;32(8):1125–36.
18. Ceelie I, de Wildt SN, van Dijk M, van den Berg MMJ, van den Bosch GE, Duivenvoorden HJ, et al. Effect of Intravenous Paracetamol on Postoperative Morphine Requirements in Neonates and Infants Undergoing Major Noncardiac Surgery. JAMA. 2013;309(2):149.
19. Neunhoeffer F, Kumpf M, Renk H, Hanelt M, Berneck N, Bosk A, et al. Nurse-driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients. Pediatric Anesthesia. 2015;25(8):786–94.
20. Hanser A, Neunhoeffer F, Hayer T, Hofbeck M, Schlensak C, Mustafi M, et al. A nurse‐driven analgesia and sedation protocol reduces length of PICU stay and cumulative dose of benzodiazepines after corrective surgery for tetralogy of Fallot. Journal for Specialists in Pediatric Nursing. 2020;25(3).
21. Dreyfus L, Javouhey E, Denis A, Touzet S, Bordet F. Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit. Ann Intensive Care. 2017;7(1):36.
22. Barnes TA, Feng HX, Herrera NA, Leathers LA. The impact of intravenous opioid shortages on postoperative pain control in a pediatric cardiac intensive care unit. J Card Surg. 2020;35(4):840–4.
23. Honarmand A, Safavi M, Kashefi P, Hosseini B, Badiei S. Comparison of effect of intravenous ketamine, peritonsillar infiltration of tramadol and their combination on pediatric post-tonsillectomy pain: A double-blinded randomized placebo-controlled clinical trial. . Res Pharm Sci. 2013;177–83.
24. Beckman EJ. Analgesia and sedation in hospitalized children. In: PedSAP 2017 Book 3: Sedation and Analgesia. Lenexa, USA: The American College of Clinical Pharmacy; 2017. p. 7–30.
25. Vet NJ, Kleiber N, Ista E, de Hoog M, de Wildt SN. Sedation in Critically Ill Children with Respiratory Failure. Front Pediatr. 2016;4.
26. Santonocito C, Noto A, Crimi C, Sanfilippo F. Remifentanil-induced postoperative hyperalgesia: current perspectives on mechanisms and therapeutic strategies. Local Reg Anesth. 2018;Volume 11:15–23.
27. Quigley C. Hydromorphone for acute and chronic pain. In: Hobson A, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2002.
28. Jeffries SA, McGloin R, Pitfield AF, Carr RR. Use of Methadone for Prevention of Opioid Withdrawal in Critically Ill Children. Can J Hosp Pharm. 2012;65(1).
29. Çoruh B, Tonelli MR, Park DR. Fentanyl-Induced Chest Wall Rigidity. Chest. 2013;143(4):1145–6.
30. Fife PA, Postier MA, Flood PA, Friedrichsdorf MFSJ. Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients. J Opioid Manag. 2016;12(2):123–30.
31. Jahr JS, Lee VK. Intravenous Acetaminophen. Anesthesiol Clin. 2010;28(4):619–45.
32. Howell KA, Ruggles CA, Thompson M, Metzger KZ, Christopher JA, Bigham MT. Using Quality Improvement to Reduce IV Acetaminophen Use in a PICU. Pediatric Critical Care Medicine. 2020;21(6):550–6.
33. de Martino M, Chiarugi A, Boner A, Montini G, de’ Angelis GL. Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal. Drugs. 2017;77(12):1295–311.
34. Gaid E, Mehta R, Waller J. The routine use of post-operative NSAIDs in the pediatric patient is effective and safe. Pediatrics. 2020;146:165–6.
35. Ismail A. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit. Pain Management Nursing. 2016;17(6):372–83.
36. Ramelet A-S, Abu-Saad HH, Rees N, McDonald S. The challenges of pain measurement in critically ill young children: A comprehensive review. Australian Critical Care. 2004;17(1):33–45.
37. Srouji R, Ratnapalan S, Schneeweiss S. Pain in Children: Assessment and Nonpharmacological Management. Int J Pediatr. 2010;2010:1–11.
38. Oakes LL. Compact Clinical Guide to Infant and Child Pain Management. D’Arcy Y, editor. New York: Springer Publishing; 2011.
39. Gélinas C, Fortier M, Viens C, Fillion L, Puntillo K. Pain assessment and management in critically ill intubated patients: a retrospective study. Am J Crit Care. 2004;13(2):126–35.
40. Turner HN. Complex Pain Consultations in the Pediatric Intensive Care Unit. AACN Clinical Issues: Advanced Practice in Acute and Critical Care. 2005;16(3):388–95.
41. Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care. Nurs Crit Care. 2009;14(3):122–30.
42. Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients. American Journal of Critical Care. 2010;19(1):55–61.
43. Ista E, van Dijk M, Tibboel D, de Hoog M. Assessment of sedation levels in pediatric intensive care patients can be improved by using the COMFORT ???behavior??? scale*. Pediatric Critical Care Medicine. 2005;6(1):58–63.
44. Ista E, de Hoog M, Tibboel D, van Dijk M. Implementation of standard sedation management in paediatric intensive care: effective and feasible? J Clin Nurs. 2009;18(17):2511–20.
45. Michel J, Hofbeck M, Gerbig I, Icheva V, Heimberg E, Jost W, et al. Nurse-driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first-stage palliation surgery: A pilot study. Pediatric Anesthesia. 2017;27(12):1261–70.
46. Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al. Epidemiology and management of painful procedures in children in Canadian hospitals. Can Med Assoc J. 2011;183(7):E403–10.
47. Welzing L, Oberthuer A, Junghaenel S, Harnischmacher U, Stützer H, Roth B. Remifentanil/midazolam versus fentanyl/midazolam for analgesia and sedation of mechanically ventilated neonates and young infants: a randomized controlled trial. Intensive Care Med. 2012;38(6):1017–24.
48. Magner C, Valkenburg AJ, Doherty D, van Dijk M, O’Hare B, Segurado R, et al. The impact of introducing nurse-led analgesia and sedation guidelines in ventilated infants following cardiac surgery. Intensive Crit Care Nurs. 2020;60:102879.
49. Khalili G, Sajedi P, Shafa A, Hosseini B, Seyyedyousefi H. A randomized evaluation of intravenous dexamethasone versus oral acetaminophen codeine in pediatric adenotonsillectomy: emergence agitation and analgesia. Middle East J Anaesthesiol. 2012;21(4):499–504.
2. Groenewald CB, Rabbitts JA, Schroeder DR, Harrison TE. Prevalence of moderate-severe pain in hospitalized children. Paediatr Anaesth. 2012;22(7):661–8. Available from: https://pubmed.ncbi.nlm.nih.gov/22332912/
3. LaFond CM, Hanrahan KS, Pierce NL, Perkhounkova Y, Laures EL, McCarthy AM. Pain in the Pediatric Intensive Care Unit: How and What Are We Doing? American Journal of Critical Care. 2019;28(4):265–73.
4. Treede R-D. The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep. 2018;3(2):e643.
5. Yudiyanta NK, Novitasari RW. Penilaian Nyeri. Jurnal Kesehatan. 2015;42(3).
6. van Dijk M, Peters JWB, van Deventer P, Tibboel DM. The COMFORT Behavior Scale. American Journal of Nursing. 2005;105(1):33–6.
7. Sehgal N, Colson J, Smith HS. Chronic pain treatment with opioid analgesics: benefits versus harms of long-term therapy. Expert Rev Neurother. 2013;13(11):1201–20.
8. Misiołek H, Cettler M, Woroń J, Wordliczek J, Dobrogowski J, Mayzner-Zawadzka E. Zalecenia postępowania w bólu pooperacyjnym — 2014. Anestezjol Intens Ter. 2014;46(4):221–44.
9. Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Pain. 2006;125(1):143–57.
10. Bailey B, Daoust R, Doyon-Trottier E, Dauphin-Pierre S, Gravel J. Validation and properties of the verbal numeric scale in children with acute pain. Pain. 2010;149(2):216–21.
11. Joestlein L. Pain, Pain, Go Away! Evidence-Based Review of Developmentally Appropriate Pain Assessment for Children in a Postoperative Setting. Orthopaedic Nursing. 2015;34(5):252–9.
12. Dorfman TL, Sumamo Schellenberg E, Rempel GR, Scott SD, Hartling L. An evaluation of instruments for scoring physiological and behavioral cues of pain, non-pain related distress, and adequacy of analgesia and sedation in pediatric mechanically ventilated patients: A systematic review. Int J Nurs Stud. 2014;51(4):654–76.
13. Marques B, JM C, MJ S. Postoperative Pain Assessment Methods for Infants and Young Children: A Review. Journal of Clinical Research in Pain and Anaesthesia. 2019;1(1):180004.
14. Laures E, LaFond C, Hanrahan K, Pierce N, Min H, McCarthy AM. Pain Assessment Practices in the Pediatric Intensive Care Unit. J Pediatr Nurs. 2019;48:55–62.
15. Herr K, Coyne PJ, McCaffery M, Manworren R, Merkel S. Pain Assessment in the Patient Unable to Self-Report: Position Statement with Clinical Practice Recommendations. Pain Management Nursing. 2011;12(4):230–50.
16. Harris J, Ramelet A-S, van Dijk M, Pokorna P, Wielenga J, Tume L, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med. 2016;42(6):972–86.
17. Playfor S, Jenkins I, Boyles C, Choonara I, Davies G, Haywood T, et al. Consensus guidelines on sedation and analgesia in critically ill children. Intensive Care Med. 2006;32(8):1125–36.
18. Ceelie I, de Wildt SN, van Dijk M, van den Berg MMJ, van den Bosch GE, Duivenvoorden HJ, et al. Effect of Intravenous Paracetamol on Postoperative Morphine Requirements in Neonates and Infants Undergoing Major Noncardiac Surgery. JAMA. 2013;309(2):149.
19. Neunhoeffer F, Kumpf M, Renk H, Hanelt M, Berneck N, Bosk A, et al. Nurse-driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients. Pediatric Anesthesia. 2015;25(8):786–94.
20. Hanser A, Neunhoeffer F, Hayer T, Hofbeck M, Schlensak C, Mustafi M, et al. A nurse‐driven analgesia and sedation protocol reduces length of PICU stay and cumulative dose of benzodiazepines after corrective surgery for tetralogy of Fallot. Journal for Specialists in Pediatric Nursing. 2020;25(3).
21. Dreyfus L, Javouhey E, Denis A, Touzet S, Bordet F. Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit. Ann Intensive Care. 2017;7(1):36.
22. Barnes TA, Feng HX, Herrera NA, Leathers LA. The impact of intravenous opioid shortages on postoperative pain control in a pediatric cardiac intensive care unit. J Card Surg. 2020;35(4):840–4.
23. Honarmand A, Safavi M, Kashefi P, Hosseini B, Badiei S. Comparison of effect of intravenous ketamine, peritonsillar infiltration of tramadol and their combination on pediatric post-tonsillectomy pain: A double-blinded randomized placebo-controlled clinical trial. . Res Pharm Sci. 2013;177–83.
24. Beckman EJ. Analgesia and sedation in hospitalized children. In: PedSAP 2017 Book 3: Sedation and Analgesia. Lenexa, USA: The American College of Clinical Pharmacy; 2017. p. 7–30.
25. Vet NJ, Kleiber N, Ista E, de Hoog M, de Wildt SN. Sedation in Critically Ill Children with Respiratory Failure. Front Pediatr. 2016;4.
26. Santonocito C, Noto A, Crimi C, Sanfilippo F. Remifentanil-induced postoperative hyperalgesia: current perspectives on mechanisms and therapeutic strategies. Local Reg Anesth. 2018;Volume 11:15–23.
27. Quigley C. Hydromorphone for acute and chronic pain. In: Hobson A, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2002.
28. Jeffries SA, McGloin R, Pitfield AF, Carr RR. Use of Methadone for Prevention of Opioid Withdrawal in Critically Ill Children. Can J Hosp Pharm. 2012;65(1).
29. Çoruh B, Tonelli MR, Park DR. Fentanyl-Induced Chest Wall Rigidity. Chest. 2013;143(4):1145–6.
30. Fife PA, Postier MA, Flood PA, Friedrichsdorf MFSJ. Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients. J Opioid Manag. 2016;12(2):123–30.
31. Jahr JS, Lee VK. Intravenous Acetaminophen. Anesthesiol Clin. 2010;28(4):619–45.
32. Howell KA, Ruggles CA, Thompson M, Metzger KZ, Christopher JA, Bigham MT. Using Quality Improvement to Reduce IV Acetaminophen Use in a PICU. Pediatric Critical Care Medicine. 2020;21(6):550–6.
33. de Martino M, Chiarugi A, Boner A, Montini G, de’ Angelis GL. Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal. Drugs. 2017;77(12):1295–311.
34. Gaid E, Mehta R, Waller J. The routine use of post-operative NSAIDs in the pediatric patient is effective and safe. Pediatrics. 2020;146:165–6.
35. Ismail A. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit. Pain Management Nursing. 2016;17(6):372–83.
36. Ramelet A-S, Abu-Saad HH, Rees N, McDonald S. The challenges of pain measurement in critically ill young children: A comprehensive review. Australian Critical Care. 2004;17(1):33–45.
37. Srouji R, Ratnapalan S, Schneeweiss S. Pain in Children: Assessment and Nonpharmacological Management. Int J Pediatr. 2010;2010:1–11.
38. Oakes LL. Compact Clinical Guide to Infant and Child Pain Management. D’Arcy Y, editor. New York: Springer Publishing; 2011.
39. Gélinas C, Fortier M, Viens C, Fillion L, Puntillo K. Pain assessment and management in critically ill intubated patients: a retrospective study. Am J Crit Care. 2004;13(2):126–35.
40. Turner HN. Complex Pain Consultations in the Pediatric Intensive Care Unit. AACN Clinical Issues: Advanced Practice in Acute and Critical Care. 2005;16(3):388–95.
41. Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care. Nurs Crit Care. 2009;14(3):122–30.
42. Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients. American Journal of Critical Care. 2010;19(1):55–61.
43. Ista E, van Dijk M, Tibboel D, de Hoog M. Assessment of sedation levels in pediatric intensive care patients can be improved by using the COMFORT ???behavior??? scale*. Pediatric Critical Care Medicine. 2005;6(1):58–63.
44. Ista E, de Hoog M, Tibboel D, van Dijk M. Implementation of standard sedation management in paediatric intensive care: effective and feasible? J Clin Nurs. 2009;18(17):2511–20.
45. Michel J, Hofbeck M, Gerbig I, Icheva V, Heimberg E, Jost W, et al. Nurse-driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first-stage palliation surgery: A pilot study. Pediatric Anesthesia. 2017;27(12):1261–70.
46. Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al. Epidemiology and management of painful procedures in children in Canadian hospitals. Can Med Assoc J. 2011;183(7):E403–10.
47. Welzing L, Oberthuer A, Junghaenel S, Harnischmacher U, Stützer H, Roth B. Remifentanil/midazolam versus fentanyl/midazolam for analgesia and sedation of mechanically ventilated neonates and young infants: a randomized controlled trial. Intensive Care Med. 2012;38(6):1017–24.
48. Magner C, Valkenburg AJ, Doherty D, van Dijk M, O’Hare B, Segurado R, et al. The impact of introducing nurse-led analgesia and sedation guidelines in ventilated infants following cardiac surgery. Intensive Crit Care Nurs. 2020;60:102879.
49. Khalili G, Sajedi P, Shafa A, Hosseini B, Seyyedyousefi H. A randomized evaluation of intravenous dexamethasone versus oral acetaminophen codeine in pediatric adenotonsillectomy: emergence agitation and analgesia. Middle East J Anaesthesiol. 2012;21(4):499–504.