Defining a "baby" dose

Through their SickKids® foundation, the Hospital of Sick Children’s Anesthesia and Pain Management department launched a pediatric pain management app. The point-of-care app targets surgeons, pediatricians, anesthesia providers and dentists.  The appropriately named PediPain app intends to quickly and accurately provide weight and age based dosages for medications used in the management of pediatric pain.   

EDITOR'S RATING

EDITOR'S RATING

REVIEW

The PediPain app offers information covering a variety of pain management needs.  Upon opening the app, the home screen offers the user 5 pain management related areas:

  •     Drug doses
  •     Local anesthetic and opioid doses for various regional nerve blocks
  •     Medication dosing for surgical procedures
  •     Epidural dosing
  •     Pain assessment tools

When the user selects the “drugs” section, they are initial asked to enter the patient’s kilogram weight and age.  After doing so, the user is presented pharmaceuticals ranging from acetaminophen and NSAIDS to hypnotics and antipruritics.  After selecting the drug category of choice, medications that fit said category are displayed.  The user can then select the medication of choice.  After medication selection, the following are displayed:

  • recommended route(s) of administration, 
  • mg or mcg/kg dose
  • suggested administration frequency 
  • total calculated dose 

The “surgical procedures” section is divided into “minor” and “major.”  Minor is associated with intermittent IV boluses, while “major” includes IV opioid infusion.  The offered medication dosages and infusion rates correlate with those found in the “drugs” section.  Of note, this section does offer postoperative and discharge home medication suggestions.   The “epidural” section includes the initial dose and suggested infusion rates for caudal, lumbar and thoracic epidurals.  Medications offered in this section are bupivicaine with or without epinephrine as well as the opioids: fentanyl, morphine, and hydromorphone.  After selecting the desired epidural location, the medication, the calculated loading dose and infusion are displayed.  The “nerve block” portion includes multiple options, including: upper extremity blocks, lower extremity blocks, abdominal blocks, amongst others.  Selection of the desired nerve block produces the same medication dosing information provided in the “epidural” section.  The app review concludes with the “pain score tools” section.  In this area, the user is offered a multitude of pain assessment scales including: 

  • FLACC  (multiple versions)
  • NCCPC (multiple versions)
  • NRS-VAS
  • Premature Infant Pain Profile 
  • Word Scale 
  • Faces Scale

COMMENTS

The PediPain app covers an exhaustive amount of pain management information.  The highlights of the app are the route administration conversions, suggested discharge medication regimens, the doses for PCA opiates, the pain score tools and the regional anesthesia dosing. Interestingly enough, while a multitude of medication information is offered throughout this app, the app lacks a thoroughness in local anesthetics variety as well as adjuncts in the epidural and regional anesthesia sections.  While the app can be of some benefit to almost any healthcare provider, it primarily caters to anesthesia providers.  The information provided in this app most likely will not change practice but rather add confidence when prescribing or administering medications one is less familiar with.  I would have really been impressed if this app suggested and stressed various multimodal analgesic regimens.

PROS

  • Pain Assessment Tools
  • Large information quantity
  • Discharge medications
  • Route dose conversions

CONS

  • No search function
  • Lacks visual appeal
  • Lack new adjunct medication
  • Lacks various local anesthetics
  • Lacks intranasal dosing

APPLICATION SPECS

Date of review: 12/13/2014
Platform: iOS
Version: 1.2
Developer: The department of anesthesia and pain medicine from The Hospital of Sick Children
Price: $4.99

Kenneth J Taylor, DNP, MSN, CRNA