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Tips for Common Painful Procedures:
- Remember, kids ARE just little adults: they feel pain just like the bigger people!
- Don't let others convince you not to consider pain management for simple procedures because it is more convenient.
- ORAL SUCROSE
- Proven to reduce signs of distress in neonate (<1 month) for minor, painful procedures
- Use in combination with sucking (ie, a pacifier).
- Dose: 0.1ml of 24% to 2ml of 50% sucrose.
- Topical Lidocaine Creams (LMX 4, EMLA)
- Use for IV insertion (several studies has proven skilled triage nurses ar able to predict which children will need IVs)
- Use for Lumbar Puncture!
- Normally you most likely either ask someone with large muscles to hold the kid or you inject lidocaine, which can obscure your landmarks.
- Instead, place LMX4 (takes ~20minutes to produce numbness) while you are documenting, getting consent, and setting up your equipment.
- This will give good anesthesia and keep the kid comfortable (ie, still) and not distort your landmarks... making you more likely to have success.
- In neonates, you can also use Oral Sucrose Pacifer for added benefit.
References
EMSC Panel (Writing Committee) on Critical Issues in the Sedation of Pediatric Patients in the Emergency Clinical policy: Critical issues in the sedation of pediatric patients in the emergency department. Ann Emerg Med. 2008 Apr;51(4):378-99, 399.e1-57