Management of acute pain in children: Safety and efficacy of a nurse-controlled algorithm for pain relief

SummaryThe current state of acute pain management in children is known to be inadequate. Several years of awareness, teaching, and training have not been sufficient to bring satisfactory analgesic outcomes.ObjectiveThe aim of this study was to evaluate the efficacy and safety of a clinical nurse-controlled protocol (algorithm) for pain relief in children using a regular combined analgesia.MethodsTwo groups of children between 5 and 17 years of age admitted for trauma, painful medical condition, or surgery were included in this comparative prospective study. Control group (CG) data were collected immediately prior to implementation of the algorithm on the paediatric ward (AG: algorithm group). The protocol focuses on regular pain evaluation using the 0–10 point visual analogue scale (VAS, 0 = no pain, and 10 = worst imaginable pain), a regular use of combined analgesia (acetaminophen, naproxen, and morphine), and regular assessment of analgesic responses and side effects by the nursing personnel.ResultsFifty-six patients were included in each group. Both groups were comparable for gender and age as well as diagnosis at admission. Admission day one incidence of mild pain (0–3) was up to 64% in the algorithm group compared to only 25% in control group. That proportion of mild pain rises to 96% in the algorithm group at admission day two compared to a low 54% in the control group (p < 0. 0001). On the admission day, only 14% of patients in CG had regular analgesia, only 20% received a dose of anti-inflammatory agents (non-steroidal anti-inflammatory drugs, NSAIDs), and 73% received a dose of acetaminophen compared to 100% (regular analgesia, NSAIDs, and acetaminophen) for the AG. Daily mean morphine equivalent dose (MMED) was comparable in both groups, both days, yet better pain control was obtained in the AG. No difference in side effects and/or co-morbidity was observed between the groups.ConclusionsThis study shows that the use of a standardised protocol (algorithm) results in better analgesic outcomes. This is demonstrated by a significant reduction in mean patients VAS scores in AG compared to CG, by an improvement in child well being without increased opioid dosages. The safety and efficacy of this approach is based on the use of regular combined analgesia, regular pain assessment, and therapeutic decisions based on patients’ VAS score.