| ObjectiveThis article discusses the correlation and difference between the FLACC and CRIES pain assessment scales for postoperative pain assessment of infants and young children.The effects of age,type of operation,anesthesia method,gender,previous operation history and pre-procedure state on the two tools were investigated.MethodsA total of 79 infants and young children aged 2 months to 3 years who underwent elective surgery were randomly selected,with ASA grades I or II and weighing 8.82±3.75kg.The children were divided into three groups according to their ages:2 months to 1 year old?excluding 1 year old?was group A?n=47?,1year to 2 years old?excluding 2 years old?was group B?n=16?,and group C was from 2 to 3 years old?n=16?.According to the type of operation,the children were divided into three groups:abdominal operation group?group I,n=32?,perineum operation group?group II,n=38?,and trunk,limbs,head and face operation group?group III,n=9?.Group II was divided into general anesthesia group?group G,n=26?and sacral canal anesthesia combined general anesthesia group?group GC,n=12?.According to their gender,the children were divided into two groups:male group?group M,n=55?and female group?group F,n=24?.The children were divided into a group with no previous history of surgery?group NS,n=66?and a group with previous history of surgery?group S,n=13?according to the history of surgery.After entering the operating room?T1?,all the children were evaluated the pre-procedure state scores and were given dexamethasone,atropine,midazolam and propofol intravenously.The children in the group GC were performed sacral canal anesthesia and retained spontaneous breathing.Intermittent intravenous bolus injection of propofol was given to the children to maintain anesthesia.Except for group GC,the other children were intubated or were inserted laryngeal mask after intravenous injection of sufentanil and cisatracurium additionally.During the operation,mechanical ventilation was used,and anesthesia was maintained under the combination of sevoflurane,remifentanil and propofol.At the end of the operation?T2?,stop using anesthetic drugs and transfer the children to the post anesthesia care unit and wait for recovery.Postoperative analgesia was performed by multimodal analgesia such as nerve block,intravenous pump,etc.The FLACC assessment scale and the CRIES assessment scale were used to assess the postoperative pain respectively when the children was awake after anesthesia?T3?,when they was transferred out of the post anesthesia care unit?T4?,when they was transferred to the ward 2 hours later?T5?,6 hours after transfer to the ward?T6?and 12 hours after transfer to the ward?T7?.Heart rate?HR?and pulse oximetry?Sp O2?were monitored and recorded at T1,T2,T3,T4,T5,T6 and T7.The respiratory rate?RR?was recorded at T3,T4,T5,T6 and T7.Results?1?Changes in vital signsThe children's average heart rates fluctuated greatly at T1,T2 and T3.The heart rates at T1 was higher than that at T2,T3,T4,T5,T6,and T7,and the difference was statistically significant?P<0.05?.The heart rates at T3 was higher than that at T2,T4,T5,T6,and T7,and the difference was statistically significant?P<0.05?.Compared with the heart rates at T7,the heart rates at T4,T5,and T6 was higher,and the difference was statistically significant?P<0.05?.There was no statistical difference in pulse oximetry at various time points?P>0.05?,and there was no statistical difference in respiratory rates at different time points after operation?P>0.05?.?2?The difference and relevance of the two evaluation scales evaluated at different timesCompared with the FLACC pain assessment scale,the overall scores of the CRIES assessment scale was higher at T4,T5 and T6,and the difference was statistically significant?P<0.05?.At T3 and T7,there was no statistically significant difference in the evaluation results of the two evaluation scales?P>0.05?.The results showed that the two scores at T3,T4,T5 and T6 were higher than those at T7 respectively and the difference was statistically significant?P<0.05?.The CRIES assessment scale at T5 were higher than that at T3 and the difference was statistically significant?P<0.05?.At T4,T5,and T6,the CRIES score was statistically significantly higher than the FLACC assessment score in finding analgesia deficiency in children?P<0.05?.There was a strong linear positive correlation between the evaluation results of the two scales at various times after surgery,and the correlation coefficient?rs?with statistical significance?P<0.05?was between 0.717?0.884.?3?Related factorsEffects of age:The results of the two analgesic assessments in group A were statistically different at T4,T5 and T6?P<0.05?,and the results of the two analgesia assessment scales in group B were statistically different at T4?P<0.05?.The results of the two analgesic assessment scales in group C were statistically different at T5?P<0.05?.Compared with group C,the CRIES scores of group A was higher than that at T6and the difference was statistically significant?P<0.05?.Effects of surgery:The CRIES scores of Group I was higher than the FLACC scores at T4,T5 and T6,and the difference was statistically significant?P<0.05?.The CRIES score of Group II was higher than the FLACC score at T4,and the difference was statistically significant?P<0.05?.There was no statistical difference between the two scores in Group III at each time?P>0.05?.Effects of anesthesia method:The GRIES scores of the group G were higher than the FLACC scores at T4 and T5,the difference was statistically significant?P<0.05?.In the group GC,there was no statistical difference between the two scores?P>0.05?.The FLACC pain score of group G was higher than that of group GC at T3,and the difference was statistically significant?P<0.05?.Effects of gender:The GRIES scores of the group M and group F were both higher than FLACC scores at T4,T5 and T6,and the difference was statistically significant?P<0.05?.There were no statistically significant difference between the group M and group F at different moments both about the FLACC pain assessment scale and the CRIES assessment scale respectively?P>0.05?.Effect of surgical history:The CRIES scores of the group S was higher than the FLACC scores at different times,and the difference was statistically significant?P<0.05?.The CRIES scores of the group NS was higher than the FLACC scores at T4,T5 and T6,and the difference was statistically significant?P<0.05?.The CRIES pain scores of the group S was higher than that of the group NS at each time postoperatively?P<0.05?.There was no statistical difference of the FLACC score between group S and group NS at different times?P>0.05?.Effect of pre-procedure state:There was no correlation between the two assessment scales and the pre-procedure state scores at all times,and the correlation coefficient was not statistically significant?P>0.05?.ConclusionBoth the CRIES and FLACC scales can be applied to the assessment of postoperative acute pain in infants and young children.The CRIES scales can indicate the child's pain or discomfort earlier.The two scale scores are related to age,type of surgery,anesthesia method and history of previous surgery,but not to gender and pre-procedure state.The CRIES score is more suitable for pain assessment in infants and young children who were younger and with greater trauma and more severe pain. |
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