Procedural pain management patterns in academic pediatric emergency departments

Acad Emerg Med. 2007 May;14(5):479-82. doi: 10.1197/j.aem.2006.12.006. Epub 2007 Mar 15.


Objectives: To describe the current state of the art for pain and sedation management for five common pediatric emergency department (ED) procedure scenarios.

Methods: Fellowship directors of U.S. EDs with a pediatric emergency medicine fellowship training program were surveyed by mail and asked to choose the one most commonly used pain or sedation management option for five clinical scenarios: facial laceration repair, cranial computed tomography in a toddler, closed fracture reduction, neonatal lumbar puncture, and intravenous catheter insertion. Results were analyzed by using descriptive statistics, and the differences between high and low volume departments were compared by using a chi-square test.

Results: Thirty-eight of 51 fellowship programs responded (75%). The majority of respondents were fellowship directors (76%). Topical anesthetics were most commonly reported as used for a simple facial laceration (84%), whereas ketamine sedation was most popular for fracture reduction (86%). Pain management for the other scenarios was more variable. More than half of the respondents (53%) would not sedate at all for cranial computed tomography, and only 38% reported use of pharmacologic pain management for intravenous catheter insertion. The majority (74%) reported use of anesthetic (topical or injected local) for neonatal lumbar puncture. High volume departments were more likely to use pain management for intravenous catheter insertions.

Conclusions: Pain and sedation management methods for pediatric procedures continue to evolve. Despite gains, there is still room for improvement, particularly regarding intravenous catheter insertions.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics / therapeutic use
  • Catheterization, Central Venous / adverse effects
  • Chi-Square Distribution
  • Emergency Service, Hospital / organization & administration*
  • Fracture Fixation / adverse effects
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Lacerations / therapy
  • Pain / prevention & control*
  • Pediatrics*
  • Spinal Puncture / adverse effects
  • Surveys and Questionnaires
  • Tomography, X-Ray Computed
  • United States


  • Analgesics
  • Hypnotics and Sedatives