The level of pain manifested by a preverbal infant following an operation or procedure can be monitored using the pain score developed by Barrier et al. The score incorporates both neurologic and behavioral items and can be used to help control analgesic delivery. The score was developed at the Hopital Necker-Enfants-Malades in Paris, France.
Parameters:
(1) sleep during preceding hour
(2) facial expression of pain
(3) quality of cry
(4) spontaneous motor activity
(5) spontaneous excitability and responsiveness to ambient stimulation
(6) constant and excessive flexion of fingers and toes
(7) sucking
(8) global evaluation of tone
(9) consolability
(10) sociability (eye contact); response to voice, smile, real interest in face
|
Parameter |
Finding |
Points |
|
sleep during preceding hour |
none |
0 |
|
|
short naps (5-10 minutes) |
1 |
|
|
longer naps (>= 10 minutes) |
2 |
|
facial expression of pain |
marked, constant |
0 |
|
|
less marked, intermittent |
1 |
|
|
calm, relaxed |
2 |
|
quality of cry |
screaming, painful, high pitched |
0 |
|
|
modulated (can be distracted by normal sound) |
1 |
|
|
no cry |
2 |
|
spontaneous motor activity |
thrashing around, incessant agitation |
0 |
|
|
moderate agitation |
1 |
|
|
quiet |
2 |
|
spontaneous excitability and responsiveness to ambient stimulation |
tremulous, clonic movements, spontaneous Moro reflexes |
0 |
|
|
excessive reactivity to any stimulation |
1 |
|
|
quiet |
2 |
|
constant and excessive flexion of fingers and toes |
very pronounced, marked and constant |
0 |
|
|
less marked, intermittent |
1 |
|
|
absent |
2 |
|
sucking |
absent or disorganized |
0 |
|
|
intermittent (3 or 4) and stops with crying |
1 |
|
|
strong, rhythmic with pacifying effect |
2 |
|
global evaluation of tone |
strong hypertonicity |
0 |
|
|
moderate hypertonicity |
1 |
|
|
normal for age |
2 |
|
consolability |
none after 2 minutes |
0 |
|
|
quiet after 1 minute of effort |
1 |
|
|
calm before 1 minute |
2 |
|
sociability (eye contact); response to voice, smile, real interest in face |
absent |
0 |
|
|
difficult to obtain |
1 |
|
|
easy and prolonged |
2 |
postoperative pain score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0, indicating severe pain
• maximum score: 20, indicating infant is very comfortable and pain free
• The higher the score, the less pain and discomfort is felt by the infant.
• A satisfactory level of post-operative pain was associated (arbitrarily) with scores >= 15.
Specialty: Pedatrics
ICD-10: ,
