Department of Pediatrics, Universite Laval, Quebec, Canada.
Pain Med. 2010 Feb;11(2):215-23. doi: 10.1111/j.1526-4637.2009.00701.x. Epub 2009 Sep 1.
We aimed to quantify children's levels of pain and fear during needle puncture procedures in a context where intravenous sedation-analgesia seems to be effective for pain and anxiety relief. The relevance of a nonpharmacological intervention in the pharmacological regimen was evaluated.
Fear and pain were assessed by children, parents and physicians, on a visual analog scale (VAS, 0-10 cm), before and during puncture procedures. Higher scores represented more intense pain/fear.
During 4 consecutive months, 18 children were recruited, but four were excluded from analyses because they did not receive the full sedation regimen (midazolam/ketamine) (N = 14, mean age +/- SD: 9.9 +/- 3.4 years). Parents self-reported their own anxiety before the procedure (4.69 +/- 3.17), but no correlation was found with their children's self-reported fear. Before procedures, the children's fear was self-reported on a VAS by children (2.93 +/- 2.93), parents (4.45 +/- 2.87), and physicians (3.67 +/- 2.48). During procedures under sedation, the children's pain (1.71 +/- 2.74) did not correlate with the parents' (4.01 +/- 3.23) and physicians' (1.83 +/- 2.32) ratings. Children anticipating high levels of pain and fear on the VAS experienced higher levels of pain (r = 0.65, P < 0.05) and fear (r = 0.59, P < 0.05) during the procedures. Sixteen parents (16/18) agreed to participate with their children if a study evaluating hypnosis for pain and anxiety was conducted.
Sedation is effective in lowering levels of fear and pain in children during procedures, but they still anticipate fear before the procedures. Parents are anxious for their children. Future hypnotic intervention could be helpful for children as well as parents to cope with anxiety during procedures.
在静脉镇静-镇痛似乎能有效缓解疼痛和焦虑的情况下，我们旨在量化儿童在接受针刺过程中的疼痛和恐惧程度。评估非药物干预在药物治疗方案中的相关性。
在穿刺过程前后，通过儿童、父母和医生的视觉模拟量表（VAS，0-10cm）评估恐惧和疼痛，得分越高表示疼痛/恐惧越强烈。
在连续 4 个月内，共招募了 18 名儿童，但由于 4 名儿童未接受完整的镇静方案（咪达唑仑/氯胺酮）而被排除在分析之外（N=14，平均年龄+/-标准差：9.9+/-3.4 岁）。父母在手术前报告了自己的焦虑（4.69+/-3.17），但与他们孩子的自我报告恐惧没有相关性。在手术前，儿童（2.93+/-2.93）、父母（4.45+/-2.87）和医生（3.67+/-2.48）通过 VAS 自我报告儿童的恐惧。在镇静下进行手术期间，儿童的疼痛（1.71+/-2.74）与父母（4.01+/-3.23）和医生（1.83+/-2.32）的评分不相关。在 VAS 上预测疼痛和恐惧水平较高的儿童在手术过程中经历了更高水平的疼痛（r=0.65，P<0.05）和恐惧（r=0.59，P<0.05）。如果进行一项评估催眠术对疼痛和焦虑的研究，18 名儿童中有 16 名（16/18）的父母同意与他们的孩子一起参与。
镇静在降低儿童在手术过程中的恐惧和疼痛水平方面是有效的，但他们在手术前仍会感到恐惧。父母为孩子感到焦虑。未来的催眠干预对儿童和父母应对手术过程中的焦虑可能会有所帮助。
