There are several studies on the correlation of various pain-rating scales in adults but few such studies have been done on children. To gain information on the correlation of self-reporting pain scales (one verbal and two visual analog scales) with each other and with a scale based on behavioral assessment, we analyzed retrospectively the pain evaluations of 141 pediatric patients participating in our analgesic studies. Eighty-two patients were male and 59 were female. The ages ranged from 1.6 to 17.6 years. The patients were divided into three age groups. All pain-rating scales were correlated (P less than 0.001) with each other and they showed a good internal consistency. There were no differences in correlation coefficients between the age groups and the two sexes. Accordingly, any of the now-employed scales can be used in clinical analgesic studies in children on the condition that the child has comprehended the use of the scale during the preoperative visit.

The effect of the topical application of a lignocaine-prilocaine cream (EMLA) on the pain of venous cannulation was tested in a double-blind manner. Sixty boys and girls between the ages of 4 and 10 yr who were to undergo surgery participated in the study. No analgesic premedication was given and the venous cannulation was performed during the preparation for general anaesthesia. Pain was assessed by the anaesthetist and the patient using a verbal rating scale and two different pictorial scales. The effect of EMLA in the alleviation of the pain of venous cannulation was considered significantly better than placebo by both anaesthetist (P less than 0.001) and patient (P less than 0.05) (verbal scales). One conventional pictorial scale showed a statistically significant difference (P less than 0.05), but the other, based on facial expressions, did not. Local reactions to the cream were minor and transient in both groups.

Patients undergoing intraocular surgery are elderly and may have disease or be receiving medication which increases the risk of haemorrhage. We interviewed 1383 consecutive patients scheduled for eye surgery requiring retrobulbar/peribulbar block about their use of non-steroidal anti-inflammatory drugs, oral steroids and warfarin. A history of diabetes mellitus and globe axial length was noted. Medial peribulbar and inferolateral retrobulbar blocks were performed by three specialists and six doctors in training. The ensuing haemorrhages were graded as follows: 1 = spot ecchymosis; 2 = lid ecchymosis involving half of the lid surface area or less; 3 = lid ecchymosis all around the eye, no increase in intraocular pressure; 4 = retrobulbar haemorrhage with increased intraocular pressure. Acetylsalicylic acid was taken by 482 (35%) patients, non-steroidal anti-inflammatory drugs by 260 (19%) and warfarin by 76 (5.5%). Lid haemorrhages (grades 1-3) were observed in 55 patients (4.0%); in 33 of these patients the haemorrhages were spotlike (grade 1). No grade 4 haemorrhages occurred. The preoperative use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or warfarin, whether or not they had been discontinued, did not predispose to haemorrhage associated with retrobulbar/peribulbar block.

No abstract

On a pharmacokinetic basis, the maintenance dose requirements of ketorolac are similar in children, adolescents and adults.