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Voir plus de contenu de Vitamin whitening sur Facebook. Informations de compte oubliées? The injection was started subsequent to at least 3 minutes of inhalation aimed at achieving optimal sedation.
Use of these means of treatment was decided upon according to the age of the child and the degree to which the physician was familiar with him or her.
The different medical procedures, methods of distraction and therapeutic drugs were all indicated in the patient's medical records. Injections were performed by an experienced injector accustomed to applying the two localization techniques. The probe was 9 L. To apply this localization technique, two physicians were needed, one to inject the botulinum toxin and the other to hold the ultrasound probe and guide localization of the targeted muscle.
In order to avoid any positioning in a blood vessel, only once the needle had been correctly visualized in the targeted muscle and only after aspiration was the product injected. The same types of needles were used for botulinum toxin injection, regardless of the localization technique being implemented. When the injecting physicians judged that localization by ultrasound or by electrostimulation alone did not adequately discriminate the targeted muscle, they were allowed to additionally apply the other technique.
Assessment was based on two scales involving self-evaluation or hetero-evaluation: the visual analog scale VAS used by the child or the accompanying party and the behavior-based FLACC scale. Click here to see the Library ].
On the back of the ruler, ratings were scaled from 0 to Overall assessment of the pain experienced during the session was given by the child just after it ended. The parents were likewise asked to evaluate the pain their child had felt, particularly when, on account of age or communication disorders, it was impossible for the child himself to provide the assessment.
When the glacon pour maigrir 2014 were not present, evaluation was carried out by a third party attending the sessions and familiar with the child. If both the child and another person assessment had been performed, then, we used the VAS scale of the child in our analysis. The reliability and validity of the Face, Legs, Activity, Cry.
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When there were several injections during a session, evaluation pertained to the most painful moment. The variables were expressed in means with standard deviations for the quantitative values and in percentages for the qualitative values. As the distributions of the quantitative variables were not always Gaussian, we also calculated the median, the minimum and maximum values and the confidence interval. If the P value was less than 0.
SAS 9. One hundred and fifty-five sessions of intramuscular botulinum toxin injection took place from May to October The 40 injection sessions involving the upper limbs were eliminated from consideration, as were 5 sessions with patients more than 18 years of age, 2 in which the data were insufficient, and 1 because localization had been exclusively anatomical.
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The remaining sessions were analyzed. Average age of the children was An average of 5. Forty-three percent of the subjects were girls. The groups in which localization was obtained by either ultrasound or electrostimulation did not significantly differ in terms of age, number of injection sites, average duration of injection, volume injected or pre-analgesic techniques applied. As regards hydroxyzine and paracetamol, frequency of use was too low to carry out statistical analysis. As shown in Fig.
The VAS average was significantly higher in the electrostimulation group than in the ultrasound group: 4.
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The average FLACC score was significantly higher in the electrostimulation group than in the ultrasound group: 3. Our findings show that whether pain is measured by self-evaluation or by hetero-evaluation, it is significantly lower when toxin injections are carried out using ultrasound localization.
To our knowledge, this is the first study to assess the role of the localization technique chosen with regard to perception of the pain induced by botulinum toxin injections in children. During muscle localization procedures, the pain provoked by electrostimulation is well known and has been observed by all the physicians having applied the technique.
However, it was hardly obvious that lessened pain during the localization phase would lead to a significant decrease in perception of pain with regard to the injection taken as a whole. In fact, the overall procedure of intramuscular botulinum toxin injection involves numerous additional algesic elements, such as the puncture, product injection itself, and the anxiety engendered by the hospital environment. In this respect, recent studies by Brochard et al.
And yet, our study demonstrates that a less painful localization technique, in this case ultrasound, indeed affects the child's perception of pain with regard to the procedure taken as a whole. As regards quantitative pain assessment during the sessions organized for our sample, the VAS average came to 3.
Click here to see the Library ], and they are close to those already reported, particularly by Brochard et al. The study by Brochard et al. These results show that pain treatment with present-day protocols is still insufficient, and they underline the interest of ongoing attempts to develop a less painful technique. During each session, an average of 5.
On the other hand, in our study, the number of injection sites is lower 5. At times, ultrasound localization allows for injection of several muscles at a single injection site. For example, the soleus muscle and the underlying gastrocnemius muscle can receive one injection at a single site by inserting a needle more deeply and through visualization of the perimysium separating the two muscles.
Our results do not include comparative evaluation of procedure effectiveness according to the localization technique applied; that was not the objective of our study.
Use of ultrasound obviously necessitates an available ultrasound apparatus, which is expensive and requires a sizable investment when centers do not possess the device. The main limit of this study is the lack of randomization, which would have enabled us to distribute the patients between the two groups according to the localization technique applied. In point of fact, a localization technique was chosen by the injecting physician according to the availability of an ultrasound apparatus.
Another methodological limit consisted of the impossibility of blinded evaluation. Indeed, our localization technique can hardly be hidden from the patient or the caretaker assessing the pain felt by the child during the procedure. Moreover, our study was not designed to evaluate comparative effectiveness from the standpoint of the efficacy of a procedure according to the localization technique applied.
Complementary studies are necessary.
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In our study, localization using electrostimulation intensified the pain provoked by injections of botulinum toxin in our group of children. Ultrasound is an interesting technique that could help to diminish the pain experienced during the localization phase and might lead to decreased perception of pain throughout the session. Complementary studies in adult populations would be useful, and they could help to compare the effectiveness of therapeutic procedures according to the localization technique applied.
Were ultrasound apparatuses to become less expensive to acquire, and were more PRM physicians to be trained, use of the technique could grow more widespread. The authors declare that they have no conflicts of interest concerning this article. Malheureusement la réalisation de ces injections intramusculaires est parfois douloureuse rendant ce geste difficile chez soins visage besancon enfants.
Il existe plusieurs techniques de repérage à notre disposition. Depuis quelques années, le repérage par échographie se développe. Des études récentes montrent son intérêt dans les injections intramusculaires pour le traitement de la spasticité chez les enfants. Sur le verso de la réglette, la cotation se fait de 0 à Les variables ont été exprimées en moyennes avec écarts-types pour les valeurs quantitatives et en pourcentages pour les valeurs qualitatives.
La valeur de p est considérée comme significative si inférieure à 0, Le logiciel SAS version 9. Les 40 séances où les injections avaient été effectuées au niveau des membres supérieurs ont été exclues, 5 séances ont été exclues car concernant des patients âgés de plus de 18 ans, 2 pour données insuffisantes, et 1 car le repérage avait été effectué anatomiquement uniquement.