@article {10818, title = {Multicentre emergency department study found that paracetamol and ibuprofen were inappropriately used in 83\% and 63\% of paediatric cases.}, journal = {Acta Paediatr}, volume = {107}, year = {2018}, month = {2018 Oct}, pages = {1766-1774}, abstract = {

AIM: The Pain Practice in Italian Paediatric Emergency Departments assessed how appropriately analgesic drugs were being used by Italian clinicians, based on national paediatric pain guidelines.

METHODS: This was a retrospective study that involved 17 Italian members of the Pain In Pediatric Emergency Rooms group. It comprised patients up to the age of 14 years who came to hospital emergency departments with pain and were treated with paracetamol, ibuprofen or opioids, such as codeine, tramadol and morphine.

RESULTS: We studied 1471 patients who were given 1593 doses of analgesics. The median time to administration of analgesia was 25 minutes. Opioids were used in 13.5\% of the children, and usage increased with age and with more severe clinical conditions, such as trauma: 1.6\% of children under two years, 5.9\% aged 3-10 and 8.0\% aged 11-14. Inappropriate doses of paracetamol, ibuprofen and opioids were used in 83\%, 63\% and 33\% of cases, respectively. The patient{\textquoteright}s age was a critical determinant of the correct analgesic dosage; for every one-year increase in the patient{\textquoteright}s age, the probability of appropriate prescriptions rose 14.8\%.

CONCLUSION: The appropriate use of paracetamol and ibuprofen for paediatric pain in Italian emergency departments was very poor, but improved with age.

}, issn = {1651-2227}, doi = {10.1111/apa.14306}, author = {Benini, Franca and Castagno, Emanuele and Barbi, Egidio and Congedi, Sabrina and Urbino, Antonio and Biban, Paolo and Calistri, Lucia and Mancusi, Rossella Letizia} } @article {10821, title = {Needle-related pain and distress management during needle-related procedures in children with and without intellectual disability.}, journal = {Eur J Pediatr}, volume = {177}, year = {2018}, month = {2018 Dec}, pages = {1753-1760}, abstract = {

Children with intellectual disability frequently undergo needle-related procedures for diagnosis or treatment. Nevertheless, only a few studies deal with pain and distress management during the procedure in this population of children. This study aimed to investigate the number of anxiety and pain management techniques performed during needle procedure in children with intellectual disability (cases) compared to a population of children without intellectual disability (controls). This multicenter cohort study was performed from July 2016 to January 2018 in the pediatric ward of four urban hospitals in Italy. Eligible subjects were children with and without intellectual disability, from 4 to 17~years old, who needed venipuncture or intravenous cannulation for diagnosis or treatment. Use of topical anesthesia, distraction techniques, and physical or verbal comfort during procedures were recorded. Pain and anxiety scores were also recorded. Forty-seven cases and 94 controls were recruited. Three pain- and anxiety-relieving techniques were performed during the procedure in 12 (25\%) cases and in 10 controls (11\%); two techniques were performed in 23 (50\%) cases and in 26 (28\%) controls; 12 (25\%) cases and 52 (55\%) controls received only one.Conclusion: In this series, children with intellectual disability received significantly more relieving techniques, but experienced more pain and anxiety when compared to children without intellectual disability. What is Known: {\textbullet} Children with intellectual disability experience more episodes of pain than cognitively healthy ones, and almost 10\% of these episodes are due to medical procedures. What is New: {\textbullet} Children with intellectual disability despite receiving more relieving techniques during a needle-related procedure experienced more pain and anxiety when compared to healthy children.

}, keywords = {Adolescent, Anxiety, Child, Child, Preschool, Cohort Studies, Female, Humans, Intellectual Disability, Italy, Male, Pain Management, Pain Measurement, Pain, Procedural, Phlebotomy}, issn = {1432-1076}, doi = {10.1007/s00431-018-3237-4}, author = {Pascolo, Paola and Peri, Francesca and Montico, Marcella and Funaro, Mishelle and Parrino, Roberta and Vanadia, Francesca and Rusalen, Francesca and Vecchiato, Luca and Benini, Franca and Congedi, Sabrina and Barbi, Egidio and Cozzi, Giorgio} } @article {10826, title = {Off-label drugs use in pediatric palliative care.}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Nov 29}, pages = {144}, abstract = {

BACKGROUND: Paediatric palliative care (PPC) aim to ensure the control of symptoms and the best possible quality of life for patients whose underlying disease, characterized by an unstoppable evolution and negative prognosis, no longer responds to specific treatments. The scientific evidence in this context are very deficient and, in order to obtain welfare objectives consistent with the situation, in the overwhelming majority of cases the prescription of drugs is off-label for indication of use and/or for age and/or for way of administration and/or formulation. The Agenzia Italiana del Farmaco - AIFA and the Italian Society of Palliative Care (Societ{\`a} Italiana di Cure Palliative - SICP), under a dedicated working group, wrote a document that collects the scientific evidence available to support the off-label use of medicines more frequently used in PPC. The goal is to certify the consolidated off-label use of these drugs and propose their use under the Law 648/96, in the absence of data from its pivotal clinical trials. Aim of the commentary is to report the conditions for this important work and to present the 10 drugs, usually used off-label in PPC and in pain therapy, now included in Law 648/96.

CONCLUSION: This work is deemed essential to resolve, at least in part, the lack of availability of medicines researched and approved.

}, issn = {1824-7288}, doi = {10.1186/s13052-018-0584-8}, author = {De Zen, Lucia and Marchetti, Federico and Barbi, Egidio and Benini, Franca} } @article {10536, title = {First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream.}, journal = {Acta Paediatr}, volume = {106}, year = {2017}, month = {2017 May}, pages = {773-778}, abstract = {

AIM: More than 50\% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream.

METHODS: We conducted this multicentre randomised controlled trial at three tertiary-level children{\textquoteright}s hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt.

RESULTS: The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4\%) who received the warm patch and in 142 children (85.0\%) who received the cream (p = 0.03). The pain scores were similar in both groups.

CONCLUSION: This study showed that the first-time needle procedure success was 7.4\% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.

}, keywords = {Anesthetics, Local, Catheterization, Peripheral, Child, Child, Preschool, Female, Hot Temperature, Humans, Lidocaine, Lidocaine, Prilocaine Drug Combination, Male, Pain, Phlebotomy, Prilocaine, Tetracaine}, issn = {1651-2227}, doi = {10.1111/apa.13764}, author = {Cozzi, Giorgio and Borrometi, Fabio and Benini, Franca and Neri, Elena and Rusalen, Francesca and Celentano, Loredana and Zanon, Davide and Schreiber, Silvana and Ronfani, Luca and Barbi, Egidio} } @article {8294, title = {Nationwide study of headache pain in Italy shows that pain assessment is still inadequate in paediatric emergency care.}, journal = {Acta Paediatr}, volume = {105}, year = {2016}, month = {2016 May}, pages = {e200-8}, abstract = {

AIM: Italian national guidelines on pain management were published in 2010, but there is little information on how effective pain management is in paediatric emergency care, with other countries reporting poor levels. Using headache as an indicator, we described pain assessment in Italian emergency departments and identified predictors of algometric scale use.

METHODS: All Italian paediatric and maternal and child hospitals participated, plus four general hospitals. Data on all children aged 4-14 years admitted during a one-month period with headache as their chief complaint were abstracted from clinical records. Multivariable analyses identified predictors of algometric assessment, taking into account the cluster study design.

RESULTS: We studied 470 admissions. During triage, pain was assessed using a standardised scale (41.5\%), informally (15.5\%) or was not recorded (42.9\%). Only 32.1\% of the children received analgesia in the emergency department. The odds ratios for predictors of algometric assessment were non-Italian nationality (3.6), prehospital medication (1.8), admission to a research hospital (7.3) and a more favourable nurses-to-admissions ratio of 10.8 for the highest versus lowest tertile.

CONCLUSION: Despite national guidelines, paediatric pain assessment in Italian emergency care was suboptimal. Hospital variables appeared to be stronger predictors of adequate assessment than patient characteristics.

}, issn = {1651-2227}, doi = {10.1111/apa.13335}, author = {Benini, Franca and Piga, Simone and Zangardi, Tiziana and Messi, Gianni and Tomasello, Caterina and Pirozzi, Nicola and Cuttini, Marina} } @article {3500, title = {Doing without codeine: why and what are the alternatives?}, journal = {Ital J Pediatr}, volume = {40}, year = {2014}, month = {2014}, pages = {16}, abstract = {

Codeine is a mild opioid widely used as an analgesic in various age groups, including various pediatric settings. It is a prodrug that owes its analgesic effect almost entirely to the principal metabolite: morphine. The genetic polymorphisms can contribute to making the pharmacokinetics of codeine hard to predict and this it is particularly important in the pediatric population because infants and children have greater susceptibility to the side-effects of morphine. In recent years there have been several reports in the literature on the risks relating to the use of codeine. In August 2012, the American Food and Drugs Administration began to revise its recommendations for the safe use of codeine and in February 2013, established that codeine should not be used for postoperative pain control in children undergoing adenoidectomy and/or tonsillectomy and did restrict the use of this drug in the pediatric population. In June 2013, the European Medicine Agency opted the same decision. In July 2013, the Agenzia Italiana del Farmaco prohibit the use of medicines containing codeine for patients under 12~years old and recommended a limited use of the drug, in many other situations. Complying with these recommendations naturally means changing habits and treatment strategies well established in pediatric practice, but other drugs, tools and techniques available enable us to continue to assure an adequate pain control in pediatric patients, irrespective of their age and situation. The article proposes same alternatives of pain control drugs.

}, keywords = {Acetaminophen, Analgesics, Non-Narcotic, Analgesics, Opioid, Child, Codeine, Humans, Pain Measurement, Pain, Postoperative, Tonsillectomy}, issn = {1824-7288}, doi = {10.1186/1824-7288-40-16}, author = {Benini, Franca and Barbi, Egidio} }