The use of conscious sedation for pain control during forearm fracture reduction in children: does race matter?
Child; Female; Humans; Male; Pain Measurement; Cohort Studies; Logistic Models; Follow-Up Studies; Risk Assessment; Multivariate Analysis; Probability; Chi-Square Distribution; Emergency Service; adolescent; Preschool; Non-U.S. Gov't; Research Support; PedPal Lit; Comparative Study; retrospective studies; Analgesia/methods; Hospital; Fractures; Attitude to Health/ethnology; African Americans/statistics & numerical data; Bone/ethnology/radiography/surgery; Conscious Sedation/methods; European Continental Ancestry Group/statistics & numerical data; Forearm Injuries/ethnology/radiography/surgery; Fracture Fixation/methods; Injury Severity Score
Recent reports in the medical literature indicate that certain racial disparities have been identified in healthcare. The authors sought to identify the potential relationship between the use of pain medications in African-American and Caucasian children undergoing forearm fracture reduction. This retrospective cohort study was performed at a university-affiliated tertiary care children's hospital emergency department. All Caucasian and African-American patients who underwent a closed reduction of a fractured ulna or radius over the 2-year observational period were enrolled. Patients were excluded from the study if they were admitted to the hospital for an open reduction or had multiple injuries. The relationship between race, gender, insurance status, time of admission, length of stay in the emergency department, fracture characteristics, and the use of conscious sedation was analyzed. t tests, chi-square tests, and stepwise logistic regression were used for data analysis. A total of 503 patients were included, 83% Caucasian and 17% African-American. Four hundred four patients received conscious sedation as part of their fracture reduction procedure and 99 did not. Univariate analysis showed that African-American and Caucasian children had different forearm fracture patterns (P = 0.0116) and different severities of angulation (P = 0.0094). Multivariate statistical analysis revealed that higher amounts of fracture translation (P < 0.0001) and angulation (P < 0.0027) and younger age of the patient (P = 0.0059) were significant predictors of conscious sedation use. Race was not found to be significantly associated with the use of conscious sedation (P = 0.0606 in univariate analysis, P = 0.1678 in multivariate analysis). The authors found that the decision to use conscious sedation for pediatric forearm fractures was not influenced by race, but was influenced by certain fracture characteristics and patient age.
2006
VanderBeek BL; Mehlman CT; Foad SL; Wall EJ; Crawford AH
Journal of Pediatric Orthopaedics
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Sedation for procedures in children: a guide for the non-anaesthetist
Child; Humans; PedPal Lit; Body Weight; Analgesia/methods; Conscious Sedation/methods; Anesthesia/methods; Pain/prevention & control
2006
British Journal of Hospital Medicine
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Difficult pain
Humans; Analgesics; Neuralgia; Forecasting; PedPal Lit; Nervous System Diseases/complications; Methadone/therapeutic use; Analgesia/methods; Opioid/therapeutic use; Palliative Care/methods; Psychotherapy/methods; Acupuncture/methods; Pain/etiology/prevention & control
2006
Colvin L; Forbes K; Fallon M
Bmj
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Ensuring pain relief for children at the end of life
Child; Female; Humans; Male; adolescent; Preschool; infant; Palliative Care/methods; Analgesia/methods; Pain Measurement/methods; Terminal Care/methods; Pain/etiology/psychology/therapy
2006
Gregoire MC; Frager G
Pain Research & Management : The Journal Of The Canadian Pain Society = Journal De La Societe Canadienne Pour Le Traitement De La Douleur
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Fast fact and concepts #107: Controlled sedation for refractory symptoms: Part II
Analgesics; Analgesia/methods; Anesthesia/methods
This fact fact will review sedation techniques.
2004
Salacz ME; Weissman DE
2004
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Journal Article
Control of severe pain in children with terminal malignancy
Child; Female; Male; Preschool; Non-U.S. Gov't; infant; retrospective studies; Pain/drug therapy; Infusions; Human; Parenteral; Support; Adolescence; Terminal Care; Neoplasms/physiopathology; Palliative Care/methods; Analgesia/methods; Morphine/administration & dosage/therapeutic use
OBJECTIVE: To identify the characteristics of the subset of children with malignancy in whom massive opioid infusions are needed during the terminal phase. DESIGN: Retrospective review of the records of the 199 patients who died of malignancy after treatment at Children's Hospital, Boston, from March 1989 to July 1993, identifying characteristics of patients who required massive opioid infusions (operationally defined as infusion of > 3 mg/kg per hour of morphine dose equivalent) during the terminal phase. RESULTS: Twelve patients (6%) required massive opioid infusions, and eight of these patients required extraordinary measures (epidural or subarachnoid infusion and/or sedation) to achieve adequate analgesia. The duration of epidural or subarachnoid infusions in three patients ranged from 3 to 9 days, and minimal complications occurred. The duration of sedation ranged from 1 to 15 days. Maximal intravenous opioid dosing ranged from 3.8 to 518 mg/kg per hour of morphine equivalent. The maximal infusion rate (exceeding all previous published reports) occurred in an infant with an isolated metastasis in the periaqueductal gray matter, a brain-stem site linked to mediating analgesia and defense reactions. The need for massive opioid dosing in 11 of 12 patients was associated with tumor spread to the spinal nerve roots, nerve plexus, large peripheral nerve, or spinal cord compression. CONCLUSIONS: Standard dosing of opioids adequately treats most cancer pain in children; however, a significant group requires more extensive management. These problems occur more commonly among patients with solid tumors metastatic to spine and major nerves.
1995
Collins J J; Grier HE; Kinney HC; Berde CB
Journal Of Pediatrics
1995
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0022-3476(95)70370-5" target="_blank" rel="noreferrer">10.1016/s0022-3476(95)70370-5</a>
Barbiturates in the care of the terminally ill
Child; Female; Humans; Adult; "Hypnotics and Sedatives"; Ethics; Medical; Palliative Care/standards; Pain/drug therapy; Analgesia/methods; Sarcoma; Terminal Care/methods/standards; Astrocytoma/nursing; Barbiturates/administration & dosage; Ewing's/nursing; Mechanical; Multiple Organ Failure/nursing; Sarcoma/physiopathology/secondary; Spinal Cord Neoplasms/physiopathology/secondary; Spinal Neoplasms/nursing; Ventilators
1992
Truog RD; Berde CB; Mitchell C; Grier HE
The New England Journal Of Medicine
1992
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1056/nejm199212033272311" target="_blank" rel="noreferrer">10.1056/nejm199212033272311</a>
Optimal pain relief in infants and children
Humans; infant; Pain Measurement; infant; Newborn; Pain/drug therapy; Analgesia/methods; Morphine/therapeutic use; Anesthesia/methods; Anesthetics/therapeutic use
1993
Burrows FA; Berde CB
Bmj (clinical Research Ed.)
1993
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/bmj.307.6908.815" target="_blank" rel="noreferrer">10.1136/bmj.307.6908.815</a>
Can we use methadone for analgesia in neonates?
Child; Humans; infant; Adult; Analgesics; Methadone; Preschool; Newborn; Drug Tolerance; Analgesia/methods; Opioid/adverse effects
2001
Chana SK; Anand KJ
Archives Of Disease In Childhood. Fetal And Neonatal Edition
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/fn.85.2.f79" target="_blank" rel="noreferrer">10.1136/fn.85.2.f79</a>
What do plasma beta-endorphin levels reveal about endogenous opioid analgesic function?
Female; Humans; Male; Adult; Middle Aged; Double-Blind Method; Cross-Over Studies; beta-Endorphin/blood; Biomarkers of Pain; Acute Pain/blood/physiopathology; Analgesia/methods; Chronic Pain/blood/physiopathology; Low Back Pain/blood/physiopathology; Naloxone/pharmacology; Narcotic Antagonists/pharmacology; Pain Measurement/drug effects; Pain Threshold/drug effects/physiology; Physical Stimulation
Bruehl S; Burns JW; Chung OY; Chont M
European Journal Of Pain
2012
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1002/j.1532-2149.2011.00021.x" target="_blank" rel="noreferrer">10.1002/j.1532-2149.2011.00021.x</a>