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The Effect of Entonox, Play Therapy and a Combination on Pain Relief in Children: A Randomized Controlled Trial
Simi Mohan1, Ruma Nayak2, Reju Joseph Thomas3
1C.S.I. College of Nursing, Dr.S.M.C.S.I.Medical College, Karakonam, Kerala, India.
Insights
Entonox and play therapy effectively reduce pediatric procedural pain. Both interventions offer significant pain relief compared to standard care, with no added benefit from combining them.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Child Psychology
Background:
- Pediatric procedural pain is frequently undertreated due to various clinical challenges.
- Rapid, low-dose interventions are needed to manage pain while keeping children alert for quick discharge.
Purpose of the Study:
- To evaluate the efficacy of Entonox, play therapy, and their combination in alleviating procedural pain in children aged 4-15 years.
- To compare these interventions against existing standard care for acute pain relief.
Main Methods:
- A randomized controlled trial involving 123 children, divided into four groups: Entonox, play therapy, combination, and control.
- Pain assessment using the FLACC scale (4-9 years) and Wong Bakers Faces Pain Scale (10-15 years).
- Data analysis using SPSS with descriptive and inferential statistics.
Main Results:
- All three interventions (Entonox, play therapy, combination) significantly reduced pain scores compared to the control group (p = .002).
- No significant difference in pain reduction was found among the three experimental groups (p = .350).
- Mean pain scores: Entonox (2.87), Play therapy (4.00), Combination (3.00), Control (5.87).
Conclusions:
- Entonox and play therapy are effective in managing pediatric procedural pain.
- Play therapy demonstrates comparable efficacy to Entonox for pain relief.
- Combining play therapy and Entonox does not yield additive pain relief benefits.
Abstract:
Pediatric pain is often undertreated/neglected due to time constraints, difficulties in timing of oral analgesics, fear of side effects of opioids and anxiolytics, and apprehension of additional pain in the use of local anesthetic injections. In this study, the researcher was prompted to choose rapidly acting interventions that were low dose and allowed the child to stay alert, suitable for a quick discharge. The purpose of this study was to evaluate the effects of Entonox, play therapy, and a combination to relieve procedural pain in children aged 4-15 years. The study was designed as a randomized controlled trial; the subjects were divided into four groups using a sequential allocation plan from 123 total subjects. Group A received Entonox, Group B received play therapy, Group C received both Entonox and play therapy, and Group D received existing standard interventions. The study was vetted by the departmental study review committee. The pain level was assessed using FLACC scale for children aged 4-9 years and the Wong Bakers Faces Pain Scale for children aged 10-15 years; scores ranged from 0 to 10. All the data were analyzed using SPSS 16.0 with descriptive statistics and, inferential statistics. The mean pain scores were as follows: Entonox group, 2.87; Play therapy group, 4; combination group, 3; and control group, 5.87. When statistical testing was applied, a significant reduction in the pain score in all the three experimental groups when compared to the control group was found (p = .002), but not in the pain score among the three experimental groups (p = .350). The findings of this study indicated that all three interventions were effective in lowering pain scores when compared to the control group. Play therapy is as potent as Entonox in relieving procedural pain, though there was no additive effect on pain relief when play therapy and Entonox were combined. A protocol for age-related choice between play therapy and Entonox administration was introduced as a standing order in the Pediatric Surgery department for acute procedural pain relief.
