Pediatrik Hastalarda Postoperatif Dönemde Ağrı ve Deliryumu Ayırt Etmede FLACC ve OPS Ölçeklerinin Karşılaştırılması

Abstract

Amaç: Postoperatif ağrı ve pediyatrik deliryum (ED) postoperatif erken dönem negatif davranışlarıdır. Ancak birbirinden ayırt etmek çok zordur. Bu çalışmanın amacı, postoperatif erken dönemde ağrıyı ve ED'yi ayırmada FLACC ve OPS ölçeğinin kullanılabilirliğini karşılaştırmaktır.

Materyal ve Metot: Bu prospektif çalışma bir üniversite hastanesinde yürütülmüştür. Altmış bir (61) çocuk çalışmaya dâhil edilmiştir. Tüm çocuklara genel anestezi uygulanmıştır. ED insidansı PAED skalası ile ağrı insidansı postoperatif dönemde hem FLACC hem de OPS skalaları ile değerlendirilmiştir. 

Bulgular: En az bir değerlendirme zamanında, sadece deliryumlu çocuk sayısı 29 (%47,5), ağrısı olan çocuk sayısı 10 (%16,4) ve hem deliryum hem de ağrısı olan çocuk sayısı 25 (%40,9) idi. FLACC için 5. dakikada eğrinin altındaki alan (AUC = 0.914, P = 0.02) ve 15. dakikada eğrinin altındaki alan (AUC = 0.865, P <0.001) yüksekti. 

Sonuç: FLACC' in pediyatrik hastalarda postoperatif dönemde ağrı ve deliryumu ayırt etmede kullanılabilirlği OPS'dan daha iyidir. 

Keywords

• ağrı
• FLACC skalası
• OPS skalası
• PAED skalası
• deliryum

The Comparison of FLACC and OPS Scales in Differentiating Pain and Emergence Delirium in the Postoperative Period in Pediatric Patients

Abstract

Objective: Postoperative pain and pediatric emergence delirium (ED) are early-postoperative negative behaviours. However it is very difficult to diferentiate each other. The aim of the present study is to compare the utility of “Face, legs, Activity, Cry, Consolability” (FLACC) and Objective Pain Scale (OPS) in differentiating the pain and ED in the early postoperative period.

Materials and Methods: This prospective study was conducted at a university hospital. Sixty one (61) children were included in this study. General anesthesia was provided for all children. The incidence of ED was evaluated with PAED scale, the incidence of pain was evaluated with both FLACC and OPS scales in the early postoperative period. 

Results: Only the number of children with delirium were 29 (47.5%), with pain were 10 (16.4%) and with both delirium and pain were 25 (40.9%). For FLACC, the area under the curve (AUC = 0.914, p = 0.02) at the 5th minute and the area under the curve value (AUC = 0.865, p < 0.001) at the 15th minute was high.

Conclusions: The utility of FLACC is better than OPS in differentiating pain and emergence delirium in the postoperative period in pediatric patients. 

Keywords

• Pain
• delirium
• FLACC scale
• OPS scale
• PAED scale

References

1. Holly MacDonell. Emergence Delirium: Causation, Correlation and Improvements Needed. EC Pulmonology and Respiratory Medicine. 2019;8:623-629. 
2. Wong DDL, Bailey CR. Emergence delirium in children. Anaesthesia. 2015;70(4):383–387. 
3. Bajwa S, Fanzca DC, Drcog AMC. A comparison of emergence delirium scales following general anaesthesia in children. Paediatr Anaesth. 2010;20:704-711. 
4. Sikich N and Lerman J. Development and psychometric evaluation of the pediatric anaesthesia emergence delirium scale. Anesthesiology. 2004;100:1038-1045. 
5. Pancekauskaitė G, Jankauskaitė L. Paediatric Pain Medicine: Pain Differences, Recognition and Coping Acute Procedural Pain in Paediatric Emergency Room. Medicina (Kaunas). 2018;54(6):94. doi:10.3390/medicina54060094 
6. Buttner W, Finke W, Büttner W, Finke W. Analysis of Behavioural and Physiological Parameters for the Assessment of Postoperative Analgesic Demand in Newborns, Infants and Young Children: A Comprehensive Report on Seven Consecutive Studies. Paediatr Anaesth. 2000;10:303–318. doi: 10.1046/j.1460-9592.2000.00530.x
7. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293–297.
8. Broadman LM, Rice LJ, Hannallah RS. Testing the validity of an objective pain scale for infants and children. Anesthesiology. 1988;69:A770.

9. Somaini M, Engelhardt T, Fumagalli R, et al. Emergence delirium or pain after anaesthesia–how to distinguish between the two in young children: a retrospective analysis of observational studies. Br J Anaesth. 2016;116:377–383.
10. Tuomilehto H, Kokki H, Ahonen R, Nuutinen J. Postoperative Behavioral Changes in Children After Adenoidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(10):1159–1164. doi:10.1001/archotol.128.10.1159
11. Lee CA. Paediatric emergence delirium: an approach to diagnosis and management in the postanaesthesia care unit. Perioper Crit Intensive Care Nurs. 2017;3:140. doi:10.4172/2471-9870.10000140
12. Somaini M, Sahillioğlu E, Marzorati C, Lovisari F, Engelhardt T, Ingelmo PM. Emergence delirium, pain or both? A challenge for clinicians. Paediatr Anaesth. 2015;25(5):524-529. doi:10.1111/pan.12580
13. Aldakhil SK, Salam M, Albelali AA, Alkanhal RM, Alnemer MJ, Alatassi A. The prevalence of emergence delirium and its associated factors among children at a postoperative unit: A retrospective cohort at a Middle Eastern hospital. Saudi J Anaesth. 2020;14(2):169-176. doi:10.4103/sja.SJA_573_19
14. Mehrotra S. Postoperative anaesthetic concerns in children: Postoperative pain, emergence delirium and postoperative nausea and vomiting. Indian J Anaesth. 2019;63(9):763-770. doi:10.4103/ija.IJA_391_19
15. Nair S, Wolf A. Emergence delirium after paediatric anaesthesia: new strategies in avoidance and treatment. BJA Education. 2018;18(1):30-33.
16. Mohkamkar M, Farhoudi F, Alam-Sahebpour A, Mousavi SA, Khani S, Shahmohammadi S. Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia. Iran J Pediatr. 2014;24(2):184-190.
17. Kain ZN, Caldwell-Andrews AA, Maranets I. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesthesia & Analgesia. 2005;99(6):1648-54.