Pain management assessment in children with limb fractures in an emergency service
Introduction: The tool most widely used for measuring the intensity of pain in children is the Faces Pain Score - Revised (FPS-R). Pain management depends on the level of care and the knowledge of the physician regarding dosing, indications and side effects of the medications available for use.
Objective: To assess pain management in patients 3-17 years of age with limb fractures using the FPS-R within the first 6 h.
Materials and methods: Observational cohort of patients 3-17 years of age presenting with limb fractures between October 2013 and January 2014. Patients with comorbidities associated with chronic pain were excluded. The tool was administered four times in accordance with the validated instructions - on admission, at first hour, at three hours and at six hours.
Results: Overall, 60 patients were assessed and 4 pharmacological regimens were identified: dipyrone alone (63.3%), combined therapy with dipyrone plus tramadol (10%), tramadol alone (8.3%), acetaminophen alone (6.6%).
The mean pain intensity reduction with the use of dipyrone was 1.7 points on the FPS-R within the first hour, with a mean reduction of 4 points by the end of the six hours of follow-up. With tramadol, pain reduction was 1.6 points and 4.6 points, respectively. The combined use of dipyrone plus tramadol did not result in significant pain reduction within the first hour.
Conclusion: Fracture immobilization is the mainstay for analgesia but it does not suffice as a form of pain management. Monotherapy with dipyrone or tramadol resulted in the best pain reduction, whereas the combined use of dipyrone plus tramadol was not better than the use of either medication alone.
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