Evidence tablesEvidence tables are <strong>in</strong>tended to allow the reader a rapidassessment of the strength of support<strong>in</strong>g evidence for <strong>in</strong>dividualanalgesics or analgesic strategies relevant to theprocedure <strong>in</strong> question. Evidence tabled as ‘Direct’ is thatderived from studies that have specifically <strong>in</strong>vestigated theprocedure <strong>in</strong> question. ‘Indirect’ evidence is derived fromstudies of procedures that the committee considered to besufficiently similar, <strong>in</strong> terms of expected pa<strong>in</strong> <strong>in</strong>tensity, toallow extrapolation of evidence. Recommendations havenot been formulated on the basis of <strong>in</strong>direct evidence.1.4 Methodology <strong>and</strong> evidence grad<strong>in</strong>g,good practice po<strong>in</strong>tsSystematic methods were used to search for evidence.Electronic searches were performed on the publishedliterature between January 2006 <strong>and</strong> December 2011.Search strategies <strong>in</strong>clud<strong>in</strong>g databases <strong>and</strong> keywords aredescribed <strong>in</strong> detail <strong>in</strong> Appendix 1, the technical report.The bibliographies of meta-analyses, systematicreviews, <strong>and</strong> review articles published dur<strong>in</strong>g this periodwere also scrut<strong>in</strong>ized for relevant articles. Studies<strong>in</strong> English were <strong>in</strong>cluded if they were directly relevantto the patient population <strong>and</strong> procedures. Abstractswere obta<strong>in</strong>ed to confirm <strong>in</strong>clusion or exclusion wherenecessary. Full text versions of <strong>in</strong>cluded articles wereobta<strong>in</strong>ed, a tabulated data extraction method was usedto summarize the articles, <strong>and</strong> they were graded from1 to 4 accord<strong>in</strong>g to the criteria <strong>in</strong> Table 1.Table 1 Criteria for assign<strong>in</strong>g levels of evidenceEvidence levels1 1++ High quality meta-analyses, systematic reviews of RCTs,or RCTs with a very low risk of bias1+ Well-conducted meta-analyses, systematic reviews of RCTs,or RCTs with a low risk of bias1) Meta-analyses, systematic reviews of RCTs, or RCTs with ahigh risk of bias2 2++ High quality systematic reviews of case–control or cohortstudies. High quality case–control or cohort studies with a verylow risk of confound<strong>in</strong>g, bias, or chance <strong>and</strong> a high probabilitythat the relationship is causal2+ Well-conducted case–control or cohort studies with a lowrisk of confound<strong>in</strong>g, bias, or chance <strong>and</strong> a moderate probabilitythat the relationship is causal2) Case–control or cohort studies with a high risk ofconfound<strong>in</strong>g, bias, or chance <strong>and</strong> a significant risk that therelationship is not causal3 Non-analytic studies, e.g. case reports, case series4 Expert op<strong>in</strong>ionRecommendations were formulated, where appropriate,<strong>and</strong> graded from A to D accord<strong>in</strong>g to the criteriadescribed <strong>in</strong> Table 2 us<strong>in</strong>g guidance published bythe Scottish Intercollegiate Guidel<strong>in</strong>es Network(SIGN), which are available at: http://www.sign.ac.uk/methodology/<strong>in</strong>dex.html <strong>and</strong> the National Instituteof Cl<strong>in</strong>ical Evidence (NICE) http://guidance.nice.org.uk.Table 2 Grad<strong>in</strong>g of recommendationsABCDAt least one meta analysis, systematic review, or RCT ratedas 1++, <strong>and</strong> directly applicable to the target population; or Asystematic review of RCTs or a body of evidence consist<strong>in</strong>gpr<strong>in</strong>cipally of studies rated as 1+, directly applicable to the targetpopulation, <strong>and</strong> demonstrat<strong>in</strong>g overall consistency of resultsA body of evidence <strong>in</strong>clud<strong>in</strong>g studies rated as 2++, directlyapplicable to the target population, <strong>and</strong> demonstrat<strong>in</strong>g overallconsistency of results; or Extrapolated evidence fromstudies rated as 1++ or 1+A body of evidence <strong>in</strong>clud<strong>in</strong>g studies rated as 2+, directly applicableto the target population <strong>and</strong> demonstrat<strong>in</strong>g overall consistency ofresults; or Extrapolated evidence from studies rated as 2++Evidence level 3 or 4; or Extrapolated evidence from studies ratedas 2+<strong>Good</strong> practice po<strong>in</strong>ts <strong>in</strong>dicate best practice based onthe cl<strong>in</strong>ical experience <strong>and</strong> op<strong>in</strong>ion of the guidel<strong>in</strong>edevelopment committee but not necessarily supportedby research evidence; they are provided <strong>in</strong> situationswhere published evidence is <strong>in</strong>sufficient to make aformal recommendation but the committee wish toemphasize an important aspect of good practice.1.5 Supplementary materialThe follow<strong>in</strong>g supplementary material is available forthis guidel<strong>in</strong>e:Appendix 1. Technical ReportAppendix 2. Implementation, cost effectiveness <strong>and</strong>auditAppendix 3. Research implicationsPlease note: Wiley-Blackwell are not responsible forthe content or functionality of any supplementarymaterials supplied by the authors. Any queries (otherthan miss<strong>in</strong>g material) should be directed to the correspond<strong>in</strong>gauthor for the article.2 ª 2012 Blackwell Publish<strong>in</strong>g Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79
1.6 Contact <strong>in</strong>formationCorrespondence <strong>in</strong> relation to this guidel<strong>in</strong>e should beaddressed to:Dr RF Howard FRCA FFPMRCAAssociation of Paediatric Anaesthetists of GreatBrita<strong>in</strong> <strong>and</strong> Irel<strong>and</strong>21 Portl<strong>and</strong> PlaceLondon W1B 1PY, UKapagbiadm<strong>in</strong>istration@aagbi.orgfund<strong>in</strong>g support from the follow<strong>in</strong>g: Johnson <strong>and</strong>Johnson Pharmaceutical Research LLD, GrunenthalLtd, Napp Pharmaceuticals Ltd <strong>and</strong> Wochardt UKLtd. Dr Neil S. Morton is Editor-<strong>in</strong>-Chief, PediatricAnesthesia <strong>and</strong> has received consultancy fees fromAstraZeneca, Smith & Nephew <strong>and</strong> Scher<strong>in</strong>g-Plough.His department has received research fund<strong>in</strong>g fromAbbott, AstraZeneca, Smith & Nephew <strong>and</strong> Carefusion(Alaris). The rema<strong>in</strong><strong>in</strong>g members of the guidel<strong>in</strong>edevelopment committee confirm that they have no conflictsof <strong>in</strong>terest to declare.1.7 Conflicts of <strong>in</strong>terestDr Richard Howard has acted as a Consultant <strong>and</strong>/orhis department has received research or educationalª 2012 Blackwell Publish<strong>in</strong>g Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79 3
- Page 1 and 2: PediatricAnesthesiaVolume 22 Supple
- Page 3: doi: 10.1111/j.1460-9592.2012.3838.
- Page 7 and 8: RecommendationsChildren’s self-re
- Page 9 and 10: Topical anesthetic preparations, fo
- Page 11 and 12: 2.7.6 Laparoscopic surgeryGood prac
- Page 13 and 14: In order to assess pain, effective
- Page 16 and 17: Postoperative painl NCCPC-PV (Non-C
- Page 18 and 19: 68 Broome ME, Richtsmeier A, Maikle
- Page 20 and 21: however, reductions in the response
- Page 22 and 23: increased success rate (i.e., less
- Page 24 and 25: Newer preparations such as liposoma
- Page 26 and 27: Good practice pointLubricant contai
- Page 28 and 29: most effective. There are a number
- Page 30 and 31: 12 Bellieni C, Bagnoli F, Perrone S
- Page 32 and 33: venipuncture pain in a pediatric em
- Page 34 and 35: 172 van Twillert B, Bremer M, Faber
- Page 36 and 37: necessary to ensure that the patien
- Page 38 and 39: when compared with LA alone and sal
- Page 40 and 41: Peribulbar block improves early ana
- Page 42 and 43: Analgesia Table 5.5.1 Sub-umbilical
- Page 44 and 45: was more effective with less motor
- Page 46 and 47: with using landmark techniques (205
- Page 48 and 49: Good practice pointWound infiltrati
- Page 50 and 51: Analgesia Table 5.6.4 Urological Su
- Page 52 and 53: (298). Ketorolac did not influence
- Page 54 and 55:
well as the epidural technique for
- Page 56 and 57:
Good practice pointA multi-modal an
- Page 58 and 59:
14 Grainger J, Saravanappa N. Local
- Page 60 and 61:
day-stay unit. Int J Paediatr Dent
- Page 62 and 63:
tinuous epidural infusion in childr
- Page 64 and 65:
245 Morton NS, O’Brien K. Analges
- Page 66 and 67:
321 Taenzer AH, Clark C, Taenzer AH
- Page 68 and 69:
Section 6.0AnalgesiaContents6.1 Ana
- Page 70 and 71:
enhance systemic absorption. Lidoca
- Page 73 and 74:
undergoes hepatic biotransformation
- Page 75 and 76:
tein binding are reduced and the ha
- Page 77 and 78:
a low-dose infusion but the child m
- Page 79 and 80:
Table 6.6.1 Paracetamol dosing guid
- Page 81:
steps that health care professional