Cartoon Analgesia in the Pediatric Plastic Surgery Population

Sir: The number of therapeutic procedures performed on pediatric patients by plastic surgeons outside of the operating room has increased in recent decades. These procedures, even if minimally painful, are often accompanied by significant distress and fear, requiring use of sedation and analgesia to facilitate both cooperation and immobilization, and to reduce anxiety and pain. Although many of these procedures carry little inherent risk to the patients, the administration of sedation or analgesia may add substantial risk of adverse events (most commonly, respiratory or cardiovascular depression) and significant agitation in the child along with increased cost and recovery time.1 Inadequate management of children’s pain and distress during medical procedures may negatively impact their future pain responses,2 such that any adverse effects of these procedures may pose long-term harm to a child. Therefore, although much emphasis is traditionally placed on pharmacologic sedation and analgesia, the approach to preventing and treating pain in children should be multidimensional—and ultimately include environmental and nonpharmacologic therapies for reducing distress.2 Television has an almost hypnotic ability to capture and engage the attention of children. In fact, the use of television has been shown to be more effective than active distraction in children undergoing procedures such as venipuncture.3 Overall, studies have demonstrated a significant analgesic effect and increased tolerance to pain in pediatric patients through the use of audiovisual media, including movies and cartoons.3,4 The ability of television to alleviate anxiety in children has proven effective in a number of medical settings, including magnetic resonance imaging studies, induction of anesthesia, and dental treatments.5 This combination of analgesic and anxiolytic effects of television can be harnessed to replace the need for pharmacologic sedation and analgesia during bedside pediatric surgical procedures. We successfully performed otoplasty and scar revision procedures in office on pediatric patients ranging in age from 4 to 18 years, using only local anesthesia while they were watching popular age-appropriate movies (Fig. 1). In our experience, this media-based analgesia effectively calms and distracts the patients, and manages to divert the patient’s attention away from the procedure at hand (Fig. 2). This achieves the goal of both physical immobilization and mental preoccupation, and takes focus away from pain and apprehension related to the procedure. These patients display noticeably less anxiety before, during, and after the procedure.Fig. 1.: Patient watching Babe on a television mounted in front of the office procedure chair.Fig. 2.: Patient calm and sitting still during an otoplasty procedure in the office, distracted by the motion picture displayed on the screen.Even minor medical procedures can cause significant pain and fear in children.2 With an increasing number of surgical procedures performed at the bedside, it is important to prevent and treat this resulting discomfort and anxiety and any lasting adverse outcomes. Television is an efficient and cost-effective method of reducing pain and anxiety and can be easily used during many pediatric procedures. Thus, television as a nonpharmacologic means of distraction holds strong potential for reducing the currently commonplace use of sedation and analgesics in pediatric surgical procedures performed outside of the operating room. PATIENT CONSENT Parents or guardians provided written consent for use of the patient’s image. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Don Hoang, M.D.Ann Lin, B.S.Vivi W. Chen, B.S.John F. Reinisch, M.D.Department of Plastic and Reconstructive SurgeryKeck School of MedicineUniversity of Southern California, Los AngelesLos Angeles, Calif.