Purpose or Case Report: In paediatric nuclear medicine the majority of the scans require intravenous (IV) access to deliver the radiotracers. Children and parents often cite procedural pain as the most distressing part of their child’s hospitalization. In our department, various pain management strategies including physical and psychological distraction methods and pharmacological intervention have been implemented for the reduction of procedural pain. The purpose of this study was to evaluate and compare different pain reduction strategies used in the paediatric Nuclear Medicine department.

Methods & Materials: The chart of 155 children (85 female) were reviewed retrospectively. Patients were categorized into 4 groups of 1. Maxiline (topical liposomal lidocaine) (n=17), 2. Pain Ease (vapocoolant) (n=71), 3. oral sucrose (n=48), and 4. no pharmacological intervention (n=19). Physical and psychological distraction were used in all patients. Therefore, group 4 only received physical and psychological strategies. Physical methods included supportive positioning, deep breathing, temperature considerations, massage Pressure or vibration and neonatal development strategies (e.g. non-nutritive sucking, facilitated tucking, swaddling, rocking). Psychological strategies included education, distraction with movies, books or storytelling, relaxation techniques. The pain perceived by the children after the IV access were compared in these 4 groups. Two types of pain assessment were used in this study: 1- Self reporting pain scale, and behavioural observational pain rating scale. Pain was reported on a scale 1 to 10. The average pain was also compared between patients who had one or two, and those who had more than two attempts for IV access.
Results: The average pain score was relatively low in all 4 groups (Maxiline=2.8, pain ease=2.1, sucrose=2.7, and no pharmacology=3.4). There was no statistically significant difference between the 4 groups. In particular, although the average pain was slightly more in patients who didn’t receive pharmacological intervention, it was not statistically significant. The average pain was 2.2 with one or two attempts, and 4.8 with more than two attempts.
Conclusions: Physical and psychological distraction methods are useful to reduce the pain in paediatric patients who cannot receive pharmacological intervention.