title: An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond.
abstract: BACKGROUND
  Painful procedures are common in the ED setting and beyond. Although these procedures are often essential to patient management, they can also be distressing for children, parents, and health providers. As such, it is imperative that effective pain and anxiety-minimizing strategies be used consistently in all settings where painful procedures take place for children.
  
  
  OBJECTIVE
  This review article aims to provide a summary of several strategies, which are supported by definitive and systematically reviewed evidence, that can be implemented alone or in combination to reduce procedural pain and anxiety for children in the ED and beyond.
  
  
  RESULTS
  For neonates, breastfeeding, nonnutritive sucking, swaddling, and sucrose administration have all been shown to decrease pain during painful interventions. For neonates, venipuncture is much less painful than heel lance for blood draws. For infants, there is some support for sucrose use. For infants and older children, there is strong evidence for distraction techniques. In addition, the use of fast-acting topical anesthetic creams as an alternative or adjunct to infiltrating anesthetic before laceration repair or vascular access/venipuncture is recommended. Further, buffering of lidocaine can decrease pain during injection. Lastly, if a laceration is amenable to the use of tissue adhesive, this should be preferentially used.
  
  
  CONCLUSIONS
  In summary, there currently remains a knowledge-to-practice gap in the treatment of children's procedure-related pain. This article has identified multiple age-specific methods to improve the treatment of procedural pain. These simple interventions can improve the care provided to ill and injured children.
authors.affiliation: From the *Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada, and ‡Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.forename: Tara
authors.initials: T
authors.lastname: McGrath
authors.forename: Amy L
authors.initials: AL
authors.lastname: Drendel
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000188:drug therapy / Q000517:prevention & control; D001942:Breast Feeding / Q000379:methods / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000517:prevention & control; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D055815:Young Adult