To the question of analgesia support of children in traumatologists’ outpatient practice

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BACKGROUND: The problem of adequate anesthesia in children with injuries at the prehospital stage do exists due to the lack of a universal approach to the assessment of pain syndrome intensity as well as to age restrictions for a number of medical preparations , and to difficulties in communication with young children.

AIM: To improve the quality of specialized outpatient emergency medical care for children with traumatic injuries.

METHODS: The present survey was conducted for one month, and 113 orthopedic traumatologists from children's trauma centers and emergency traumatologic and orthopedics departments of medical organizations subordinated to the Moscow Healthcare Department participated in it. Each participant was offered a questionnaire having 24 thematic sections on analgesics application in their outpatient practice at various stages of prehospital care for children with mild and moderate traumatic injuries. At the same time, in a number of sections, several answers could be selected by a participant.

RESULTS: The obtained results demonstrated that there is no any unified systematic approach to the pain management after mild and moderate injuries in children. Analgesia techniques at the outpatient stage are paid not enough attention. Many doctors are ready to give a detailed consultation on how to relief pain at home, but in some cases, parents themselves decide on how to do it, though they do not have necessary knowledge.

CONCLUSION: To develop indications for anesthesia support requires the implementation of specialized pain assessment scales differentiated by age groups, development of methodological recommendations and standards for analgesics application at the prehospital stage with comprehensive information on existing forms and age-related features of effective and safe medical preparations of recent generations.

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作者简介

Dmitry Vybornov

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: vybornovdy@zdrav.mos.ru
ORCID iD: 0000-0001-8785-7725
SPIN 代码: 2660-5048

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow; 15 Sadovaya-Kudrinskaya street, 123001 Moscow

Aleksandr Nekrutov

Research Institute for Healthcare Organization and Medical Management; Clinical and Research Institute of Emergency Pediatric Surgery and Trauma

编辑信件的主要联系方式.
Email: nekrutovav@zdrav.mos.ru
SPIN 代码: 6600-8961

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow; Moscow

Nikolay Semenov

Research Institute for Healthcare Organization and Medical Management

Email: semenovnyu@mail.ru

MD

俄罗斯联邦, Moscow

Konstantin Khmelnitsky

Research Institute for Healthcare Organization and Medical Management

Email: semenovnyu@mail.ru

MD

俄罗斯联邦, Moscow

Andrey Ilyin

Research Institute for Healthcare Organization and Medical Management

Email: IlinAO@zdrav.mos.ru

MD

俄罗斯联邦, Moscow

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2. Fig. 1. The need for analgesia for children at the outpatient stage.

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3. Fig. 2. The time of receiving anesthesia.

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4. Fig. 3. The time from the moment of injury to receiving anesthesia.

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5. Fig. 4. The frequency of pain intensity assessment.

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6. Fig. 5. The popularity of pain assessment methods in children: ВАШ — is a visually analog scale; NIPS — Neonatal Infant Pain Scale; FLACC — Face, Legs, Activity, Cry, Consolability; CHIPPS — Children’s And Infants Postoperative Pain Scale; OPS — Objective Pain Scale.

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7. Fig. 6. Frequency of use of pain assessment methods in children: ВАШ — is a visually analog scale; NIPS — Neonatal Infant Pain Scale; FLACC — Face, Legs, Activity, Cry, Consolability; CHIPPS — Children’s And Infants Postoperative Pain Scale; OPS — Objective Pain Scale.

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8. Fig. 7. The frequency of documenting pain symptoms.

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9. Fig. 8. Factors preventing the documentation of pain symptoms.

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10. Fig. 9. The need for analgesia at the stage of primary administration.

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11. Fig. 10. The grounds for prescribing analgesia.

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12. Fig. 11. Drugs and methods of anesthesia at the initial admission.

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13. Fig. 12. The use of oral analgesics at the initial intake.

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14. Fig. 13. The validity of the choice of oral analgesics.

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15. Fig. 14. Drugs for analgesia in children under 12 years of age.

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16. Fig. 15. Drugs for analgesia in children over 12 years of age.

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17. Fig. 16. The frequency of anesthesia before performing manipulations.

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18. Fig. 17. The frequency of pain relief methods before performing manipulations.

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19. Fig. 18. The frequency of pain assessment in dynamics.

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20. Fig. 19. The frequency of issuing recommendations for analgesia at home after medical care.

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21. Fig. 20. The frequency of parents' requests for pain relief at home.

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22. Fig. 21. Factors in the administration of oral analgesics during home treatment.

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23. Fig. 22. The frequency of prescribing a detailed treatment regimen at home.

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24. Fig. 23. The frequency of use of drugs with a detailed treatment regimen at home.

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25. Fig. 24. The value of the prescription of an analgesic.

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版权所有 © Vybornov D.Y., Nekrutov A.V., Semenov N.Y., Khmelnitsky K.Y., Ilyin A.O., 2024

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