|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 2 | Page : 117
The use of smart phones to decrease analgesic requirements in children with chronic renal failure
Divya Jain1, Komal Gandhi1, Sumit Kumar1, Deepesh Benjamin Kenwar2
1 Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||7-Aug-2019|
Dr. Divya Jain
Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain D, Gandhi K, Kumar S, Kenwar DB. The use of smart phones to decrease analgesic requirements in children with chronic renal failure. Indian J Pain 2019;33:117
|How to cite this URL:|
Jain D, Gandhi K, Kumar S, Kenwar DB. The use of smart phones to decrease analgesic requirements in children with chronic renal failure. Indian J Pain [serial online] 2019 [cited 2020 Aug 10];33:117. Available from: http://www.indianjpain.org/text.asp?2019/33/2/117/264081
Every month about 6–8 children undergo arteriovenous fistula formation surgery for hemodialysis at our institution. Local anesthesia/brachial plexus block has gained wide acceptance for adults undergoing this procedure. However, children being noncooperative, they are generally subjected to general anesthesia for smooth conduct of this procedure.
We report the use of audio-visual distraction to reduce consumption of anesthetic and analgesic drugs in a case series of seven children undergoing arteriovenous fistula surgery. The mean age (standard deviation) (range) of the children was 8.5 (7–12) years, and weight was 23.7 (18–30) kg. The preprocedural anxiety of the children as measured by the modified Yale preoperative anxiety scale score was 38.2 (5.8).
The children were educated about the procedure, and advantages of nonpharmacological methods for pain relief were highlighted. They were counseled that they would be receive small prick (for local anesthesia) to anesthetize the concerned area. They were asked about their favorite programs or movies, which were downloaded on the smartphones. The children were made to visualize these programs on smartphones in the operation theater 15 min prior to the procedure, which was continued throughout the procedure. All the seven children successfully completed the procedure without supplementation with any intravenous analgesic or anesthetic drug. All the children were satisfied at the end of the procedure.
The adverse effects of the anesthetic and analgesic drugs are generally aggravated in these children due to chronic renal failure and other systemic involvements. Reduction in analgesic and anesthetic drugs in these patients was our major success. We believe our selection of children with lesser anxiety was one of the major contributory factors for the successful conduct of this technique. Second, the developmental age of these children was such that they could comprehend the purpose of the procedure.
Nonpharmacological methods have been extensively used as adjuvants to decrease analgesic requirements. Over the years, various techniques such as heat/cold therapy, relaxation techniques, distraction (active and passive), guided imagery, and empathy from health-care providers have been used to alleviate pain.,, Psychological preparation, education along with the distraction technique helped to successfully accomplish the procedure in our patients.
This article highlights the expansion of the domain of the nonpharmacological methods in reducing pain in the perioperative period in children who are at increased risk of side effects from analgesic and anesthetic drugs. However, future trials are required to evaluate the efficacy of this technique.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Oliveira NC, Linhares MB. Nonpharmacological interventions for pain relief in children: A systematic review. Psychol Neurosci 2015;8:28-38.
Royal Australasian College of Physicians. Management of procedure related pain in children and adolescents. Guideline statement: Paediatric and health division. J Paediatr Child Health 2006;42:51-529.
Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, et al.
Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2011;10:CD006275.
Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: Assessment and nonpharmacological management. Int J Pediatr 2010;2010. pii: 474838.