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[Management of anxious and painful manifestations in pediatric uroradiology]
Insights
For children under 5 undergoing imaging, intra-rectal midazolam effectively reduced pain and stress during intravenous pyelography (i.v.p.) and voiding cystourethrography (VCUG). Older children experienced pain reduction with nitrous oxide during i.v.p. and VCUG (girls only).
Area of Science:
- Pediatric Radiology
- Pain Management in Children
- Medical Imaging Procedures
Background:
- Pediatric patients undergoing imaging procedures like intravenous pyelography (i.v.p.) and voiding cystourethrography (VCUG) often experience significant pain and stress.
- Effective pain and stress management is crucial for successful diagnostic imaging and patient cooperation.
- Current strategies for managing procedural discomfort in pediatric radiology require evaluation.
Purpose of the Study:
- To assess the efficacy of intra-rectal midazolam in reducing pain and stress in young children (<5 years) during i.v.p. and VCUG.
- To evaluate the effectiveness of inhaled nitrous oxide in mitigating pain in older children (>5 years) undergoing i.v.p. and VCUG.
- To compare the impact of these interventions on pain and stress levels across different age groups and imaging modalities.
Main Methods:
- A study involving 207 children undergoing i.v.p. or VCUG.
- Children under 5 years received intra-rectal midazolam (0.5 mg/kg, max 5 mg).
- Children over 5 years inhaled an equimolar mixture of oxygen and nitrous oxide; pain was assessed using the Le Baron-Zeltzer scale (under 5) and a visual analogic scale (over 5).
Main Results:
- Intra-rectal midazolam significantly reduced pain and stress in children under 5 during both i.v.p. and VCUG (p < 0.0001).
- Nitrous oxide inhalation reduced pain during i.v.p. in children over 5 (p = 0.0004) and during VCUG in girls (p = 0.0025).
- Pain reduction with nitrous oxide was not statistically significant in boys over 5 undergoing VCUG (p > 0.05).
Conclusions:
- Intra-rectal midazolam is a highly effective agent for managing pain and stress in young children during i.v.p. and VCUG.
- Nitrous oxide provides significant pain relief during i.v.p. and in girls during VCUG for older children.
- Pediatric radiologists should actively assess and manage procedural pain and stress, as effective and safe interventions are available.
Abstract:
Two hundred and seven children undergoing either intravenous pyelography (i.v.p.) or voiding cystourethrography (VCUG) were examined. Under the age of 5 years, children received intra-rectal midazolam (0.5 mg/kg) with a maximum of 5 mg. Children over 5 years, self-inhaled an equimolar mixture of oxygen and nitrous oxide. Pain and stress were evaluated in children under 5, by the pediatric radiologist according to the 4 non verbal items of the Le Baron-Zeltzer scale and in children over 5 by the child himself with a visual analogic scale. Under 5 years of age, midazolam significantly reduced pain and stress during i.v.p. (p < 0.0001), VCUG both in boys (p < 0.0001) and girls (p < 0.0001). In children over 5, nitrous oxide inhalation reduced pain during i.v.p. (p = 0.0004), during VCUG in girls (p = 0.0025), but not in boys ((p > 0.05). Pediatric radiologists should evaluate pain and stress in their patients as they can be easily and safely limited.