Ali Samina, McGrath Tara, Drendel Amy L
From the *Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada, and ‡Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
Pediatr Emerg Care. 2016 Jan;32(1):36-42; quiz 43-4. doi: 10.1097/PEC.0000000000000669.
Painful procedures are common in the ED setting and beyond. Although these procedures are often essential to patient management, they can also be distressing for children, parents, and health providers. As such, it is imperative that effective pain and anxiety-minimizing strategies be used consistently in all settings where painful procedures take place for children.
This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in the ED and beyond.
For neonates, breastfeeding, nonnutritive sucking, swaddling, and sucrose administration have all been shown to decrease pain during painful interventions. For neonates, venipuncture is much less painful than heel lance for blood draws. For infants, there is some support for sucrose use. For infants and older children, there is strong evidence for distraction techniques. In addition, the use of fast-acting topical anesthetic creams as an alternative or adjunct to infiltrating anesthetic before laceration repair or vascular access/venipuncture is recommended. Further, buffering of lidocaine can decrease pain during injection. Lastly, if a laceration is amenable to the use of tissue adhesive, this should be preferentially used.
In summary, there currently remains a knowledge-to-practice gap in the treatment of children's procedure-related pain. This article has identified multiple age-specific methods to improve the treatment of procedural pain. These simple interventions can improve the care provided to ill and injured children.
痛苦的操作在急诊科及其他场景中很常见。虽然这些操作通常对患者管理至关重要，但它们也可能让儿童、家长和医护人员感到痛苦。因此，在所有对儿童进行痛苦操作的场景中，必须始终如一地使用有效的减轻疼痛和焦虑的策略。
这篇综述文章旨在总结几种有确凿且经过系统综述证据支持的策略，这些策略可以单独实施或联合实施，以减轻急诊科及其他场景中儿童的操作相关疼痛和焦虑。
对于新生儿，母乳喂养、非营养性吸吮、襁褓包裹和给予蔗糖均已被证明可减轻痛苦干预期间的疼痛。对于新生儿，静脉穿刺采血比足跟采血痛苦小得多。对于婴儿，有一些证据支持使用蔗糖。对于婴儿和大龄儿童，有强有力的证据支持采用分散注意力的技巧。此外，建议在伤口缝合或血管通路/静脉穿刺前，使用速效局部麻醉乳膏作为浸润麻醉的替代方法或辅助方法。此外，利多卡因缓冲可减轻注射时的疼痛。最后，如果伤口适合使用组织粘合剂，应优先使用。
总之，目前在儿童操作相关疼痛的治疗方面仍存在知识与实践的差距。本文确定了多种针对不同年龄段的方法来改善操作疼痛的治疗。这些简单的干预措施可以改善对患病和受伤儿童的护理。
