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The Behavioral Observational Pain Scale (BOPS) helps evaluate postoperative pain in children by observing three key behaviors: facial expression, verbalization, and body position. Each behavior is assessed with specific categories, and a numerical score is assigned accordingly to quantify the level of pain. 

Here's how it works:

Facial Expression:
- Neutral/positive, composed, calm = 0
- Negative, concerned = 1
- Grimace or distorted face = 2

Verbalization:
- Normal conversation, laugh, crow = 0
- Completely quiet, sobbing/complaining not due to pain = 1
- Crying, screaming, or complaining about pain = 2

Body Position:
- Inactive, relaxed, or sitting/walking = 0
- Restless, shifting, or touching wound area = 1
- Rigid or curled up posture = 2

To compute the total score, select the category that best matches each observed behavior, convert these selections into scores using the provided scale, and sum them up. The combined score reveals the interpretation:

- A total score between 0 and 2 suggests "Mild or no pain."
- A total score from 3 to 6 indicates "Significant pain."

This system allows for an objective assessment and provides guidance for managing postoperative care based on observable behavioral indicators.

The Behavioral Observational Pain Scale for Postoperative Pain in Children (BOPS) is a clinical calculator specifically designed to assess postoperative pain in pediatric patients. This scoring system is particularly useful in children who are unable to verbally communicate their pain levels, such as those who are very young or have cognitive impairments. The BOPS evaluates various behavioral indicators of pain, including facial expression, body movements, and vocalizations. The clinical utility of this calculator lies in its ability to guide pain management strategies, ensuring that children receive appropriate analgesia following surgery. It is not applicable or valid for use in adults or in children who are able to effectively communicate their pain levels.

Behavioral observational pain scale for postoperative pain in children (BOPS)

The Apfel score is a tool used to predict the risk of postoperative nausea and vomiting (PONV). It assesses four risk factors:

- Gender
- Smoking status
- History of motion sickness or prior PONV
- Use of postoperative opioids

Here's how it works:

Each factor contributes to a numerical score:

- Gender: Female patients score 1 point, while male patients score 0.
- Smoking Status: Non-smokers score 1 point, while smokers score 0.
- History of Motion Sickness or PONV: Those with a history score 1 point, and those without score 0.
- Use of Postoperative Opioids: Patients using opioids post-surgery score 1 point, while those who do not score 0.

The scores from each category are summed to give a total score ranging from 0 to 4. The interpretation of the score is as follows:

- A score of 0 correlates to a 10% risk of PONV within 24 hours.
- A score of 1 corresponds to a 21% risk.
- A score of 2 suggests a 39% risk.
- A score of 3 indicates a 61% risk.
- A score of 4 predicts a 79% risk.

This systematic approach helps in assessing the likelihood of experiencing PONV, which can aid in determining preventive measures.

The Apfel Score is a clinical calculator used to predict the risk of postoperative nausea and vomiting (PONV) in surgical patients. It is named after Dr. Christian C. Apfel, who developed it. The score is based on four risk factors: female gender, history of motion sickness or PONV, non-smoking status, and the use of postoperative opioids. Each risk factor contributes one point to the score, with a maximum score of four. The higher the score, the greater the risk of PONV. 

This calculator is applicable to all adult patients undergoing surgery, particularly those under general anesthesia. It is used to guide prophylactic antiemetic therapy, with the aim of improving patient comfort and satisfaction, and reducing hospital stay and costs. 

The Apfel Score may not be applicable to pediatric patients, or to patients undergoing certain types of surgery (e.g., eye or ear surgery) that have a particularly high risk of PONV. It also does not take into account other potential risk factors for PONV, such as the type and duration of surgery, or the use of volatile anesthetics.

Apfel score for postoperative nausea and vomiting

The Behavioral Pain Scale (BPS) is a tool for assessing pain levels in intubated patients by observing three specific behavioral indicators: facial expression, upper limb movements, and compliance with mechanical ventilation. Each behavior is linked to a set of descriptive options, with each option assigned a numerical score.

The scoring is as follows:

- Facial Expression:
  - Relaxed: 1
  - Partially tightened: 2
  - Fully tightened: 3
  - Grimacing: 4

- Upper Limb Movements:
  - No movement: 1
  - Partially bent: 2
  - Fully bent with finger flexion: 3
  - Permanently retracted: 4

- Compliance with Mechanical Ventilation:
  - Tolerating movement: 1
  - Coughing but tolerating ventilation for most of the time: 2
  - Fighting ventilator: 3
  - Unable to control ventilation: 4

For each of the three indicators, the caregiver selects the option that best describes the patient's current behavior, and the associated scores are recorded. These scores are then summed to produce a total score, which can range from 3 to 12.

The total score guides the interpretation of the patient's pain level:

- A score ranging from 3 to 5 suggests "No or mild pain," indicating acceptable discomfort levels.
- A score from 6 to 12 reflects "Unacceptable amount of pain," prompting consideration for additional sedation and/or analgesia.

This scoring system provides healthcare providers with a straightforward method to evaluate and respond to the pain status of intubated patients effectively.

The Behavioral Pain Scale (BPS) is a clinical calculator used for assessing pain in intubated patients, specifically those who are unable to communicate verbally due to mechanical ventilation in the intensive care unit (ICU). The BPS is a valuable tool for healthcare providers as it helps in the objective evaluation of pain, which is crucial for appropriate pain management and improving patient comfort. 

The BPS assesses three behavioral domains: facial expression, upper limb movements, and compliance with ventilation. Each domain is scored from 1 to 4, with a total score ranging from 3 (no pain) to 12 (maximum pain). 

The BPS is not applicable to patients who are sedated or paralyzed, as their ability to exhibit behavioral responses to pain is impaired. Additionally, it may not be suitable for patients with neurological impairments or those who have received neuromuscular blocking agents, as these conditions can also affect the patient's ability to express pain behaviorally.

Behavioral Pain Scale for pain assessment in intubated patients (BPS)

The FLACC Scale is a tool used to assess pain levels in children who are unable to communicate their discomfort verbally. The scale evaluates five categories: face, legs, activity, cry, and consolability. Each category has defined behavioral indicators that help gauge the level of pain, which are assigned scores: 0, 1, or 2. Here's how the scoring works:

- **Face:**
  - No particular expression or smile: 0
  - Occasional grimace or frown, withdrawn, disinterested: 1
  - Frequent to constant quivering chin, clenched jaw: 2

- **Legs:**
  - Normal position or relaxed: 0
  - Uneasy, restless, tense: 1
  - Kicking or legs drawn up: 2

- **Activity:**
  - Lying quietly, normal position, moves easily: 0
  - Squirming, shifting back and forth, tense: 1
  - Arched, rigid, or jerking: 2

- **Cry:**
  - No cry (awake or asleep): 0
  - Moans or whimpers, occasional complaint: 1
  - Crying steadily, screams, sobs, frequent complaints: 2

- **Consolability:**
  - Content, relaxed: 0
  - Reassured by touching, hugging, or being talked to, distractible: 1
  - Difficult to console or comfort: 2

To determine the total pain score, you sum the scores of all five categories. This total provides a succinct indicator of the child's pain level.

- A score of 0 signifies that the child is relaxed and comfortable.
- Scores ranging from 1 to 3 indicate mild discomfort.
- Scores from 4 to 6 suggest moderate pain.
- A score of 7 or higher highlights severe discomfort or pain.

This scoring system allows caregivers and healthcare providers to determine and address the child's pain effectively, even when the child cannot verbally express it.

The FLACC Scale, or the Face, Legs, Activity, Cry, Consolability Scale, is a clinical calculator used to assess and quantify pain in children. It is specifically designed for children between the ages of 2 months to 7 years, or for older children with cognitive impairment who are unable to express their pain verbally. 

The FLACC Scale is a valuable tool in pediatric care, allowing healthcare providers to objectively measure a child's pain level based on five categories: facial expression, leg movement, activity level, cry, and consolability. Each category is scored from 0 to 2, resulting in a total score between 0 (no pain) and 10 (severe pain). 

This calculator is not applicable for children who can reliably self-report their pain, or for infants under 2 months of age due to their limited range of behaviors. It should also be used with caution in children with certain neurological conditions that may affect their motor responses.

FLACC Scale for assessment of pain in children

The FLACC-R Scale assesses pain in children using five criteria: Face, Legs, Activity, Cry, and Consolability. Each criterion includes specific descriptions that translate observed behaviors into numerical scores on a scale from 0 to 2, enabling caregivers to quantify the level of discomfort or pain.

To compute a score, evaluate each of the five categories using the following guidelines:

Face:
- "No particular expression or smile" scores 0
- "Occasional grimace or frown, withdrawn, disinterested, appears sad or worried" scores 1
- "Consistent grimace or frown, frequent/constant quivering chin, clenched jaw, distressed-looking face, expression of fright or panic" scores 2

Legs:
- "Normal position or relaxed, usual tone and motion to limbs" scores 0
- "Uneasy, restless, tense, occasional tremors" scores 1
- "Kicking or legs drawn up, marked increase in spasticity, constant tremors or jerking" scores 2

Activity:
- "Lying quietly, normal position, moves easily, regular, rhythmic respirations" scores 0
- "Squirming, shifting back and forth, tense or guarded movements, mildly agitated, shallow, splinting respirations, intermittent sighs" scores 1
- "Arched, rigid or jerking, severe agitation, head banging, shivering, breath holding, gasping or sharp intake of breaths, severe splinting" scores 2

Cry:
- "No cry/verbalization" scores 0
- "Moans or whimpers, occasional complaint, occasional verbal outburst or grunt" scores 1
- "Crying steadily, screams, sobs, frequent complaints, repeated outbursts, constant grunting" scores 2

Consolability:
- "Content and relaxed" scores 0
- "Reassured by touching, hugging or being talked to, distractible" scores 1
- "Difficult to console or comfort, pushing away caregiver, resisting care or comfort measures" scores 2

Sum the scores from all five categories to obtain a total that ranges from 0 to 10. This total provides an interpretation of the child's pain as follows:

- A score of 0 suggests the child is "Relaxed and comfortable."
- Scores from 1 to 3 indicate "Mild discomfort."
- Scores from 4 to 6 denote "Moderate pain."
- Scores from 7 to 10 reflect "Severe discomfort/pain."

This method provides a structured approach to understanding and interpreting the pain experienced by a child, allowing caregivers to respond in a manner appropriate to the level of discomfort indicated by the total score.

The FLACC-R Scale, or the Face, Legs, Activity, Cry, Consolability-Revised Scale, is a clinical calculator used to assess pain in pediatric patients. It is specifically designed for children aged between 2 months to 7 years, or for older children with cognitive impairment who are unable to use self-reporting pain scales. 

The FLACC-R Scale is a behavioral tool that measures five categories of pain behaviors: face, legs, activity, cry, and consolability. Each category is scored from 0 to 2, providing a total score ranging from 0 (no pain) to 10 (severe pain). 

The clinical utility of this calculator is to provide a standardized and objective measure of pain in children who cannot self-report their pain levels. It is widely used in various clinical settings, including post-operative care, emergency departments, and pediatric intensive care units. 

The FLACC-R Scale should not be used in children who can reliably self-report their pain, or in children under 2 months of age due to the developmental appropriateness of the behaviors assessed.

FLACC-R Scale for assessment of pain in children

The Richmond Agitation-Sedation Scale (RASS) assigns a numerical score to a patient's level of agitation or sedation based on their behavior. The patient's behavior is assessed using predefined descriptions, and each description corresponds to a specific RASS score.

To determine the RASS score:

1. The calculator receives an input which is the patient's description based on observed behavior.
2. The available options for patient description range from combative behavior to unarousable sedation.
3. Each description is mapped to a corresponding RASS score as follows:

   | Patient Description                                                                              | RASS Score |
   |--------------------------------------------------------------------------------------------------|------------|
   | Combative: overtly combative or violent; immediate danger to staff                               | RASS +4    |
   | Very agitated: pulls on or removes tube(s) or catheter(s) or has aggressive behavior             | RASS +3    |
   | Agitated: frequent non-purposeful movement or patient-ventilator dyssynchrony                    | RASS +2    |
   | Restless: anxious or apprehensive, but movements not aggressive or vigorous                      | RASS +1    |
   | Alert and calm                                                                                   | RASS 0     |
   | Drowsy: not fully alert, but has sustained (> 10 seconds) awakening, with eye contact, to voice  | RASS -1    |
   | Light sedation: briefly (< 10 seconds) awakens with eye contact to voice                         | RASS -2    |
   | Moderate sedation: any movement (but no eye contact) to voice                                    | RASS -3    |
   | Deep sedation: no response to voice, but any movement to physical stimulation                    | RASS -4    |
   | Unarousable sedation: no response to voice or physical stimulation                               | RASS -5    |

4. For the computation process, the patient's description is checked against each possible condition. When a match is found, the corresponding RASS score is assigned..

The Richmond Agitation-Sedation Scale (RASS) is a clinical tool used primarily in intensive care units (ICUs) to assess the level of sedation and agitation in patients. It is particularly useful in monitoring the sedation status of mechanically ventilated patients, helping to guide sedation therapy and ensure optimal patient comfort without over-sedation. The RASS score ranges from -5 (indicating unarousable sedation) to +4 (indicating combative agitation). It is not applicable to patients who are not in an ICU setting or those who are not at risk of over- or under-sedation.

Richmond Agitation-Sedation Scale (RASS)

The Critical Care Pain Observation Tool (CPOT) is designed to assess pain in patients who are unable to communicate verbally. This tool evaluates pain through four indicators: intubation status and vocalization or compliance with the ventilator, facial expression, body movements, and muscle tension. Each indicator is associated with specific responses, each mapped to a score. Here's how each is assessed:

- **Intubation status and vocalization or compliance with the ventilator**:
  - Not intubated and talking in normal tone or no sound: score of 0
  - Not intubated and sighing, moaning: score of 1
  - Not intubated and crying out, sobbing: score of 2
  - Intubated and tolerating ventilator or movement: score of 0
  - Intubated and coughing but tolerating: score of 1
  - Intubated and fighting ventilator: score of 2

- **Facial expression**:
  - Relaxed, neutral: score of 0
  - Tense: score of 1
  - Grimacing: score of 2

- **Body movements**:
  - Absence of movements: score of 0
  - Protection: score of 1
  - Restlessness: score of 2

- **Muscle tension**:
  - Relaxed: score of 0
  - Tense, rigid: score of 1
  - Very tense or rigid: score of 2

The scores from each of these indicators are summed to yield a total CPOT score. Here's what the scores indicate about the patient's pain level:

- A total score between 0 and 2 suggests "Minimal or no pain present."
- A total score of 3 or above suggests an "Unacceptable amount of pain," which may require further intervention such as sedation or analgesia.

This tool helps in quantifying pain for patients unable to communicate, facilitating critical decision-making in patient care.

The Critical Care Pain Observation Tool (CPOT) is a clinical calculator used in the critical care setting. It is specifically designed for assessing pain in patients who are unable to communicate their pain, such as those who are intubated, sedated, or unconscious. The CPOT evaluates four different aspects: facial expressions, body movements, muscle tension, and compliance with the ventilator for intubated patients or vocalization for extubated patients. Each category is scored from 0-2, with a total score ranging from 0-8. Higher scores indicate a higher level of pain. The clinical utility of the CPOT is to guide pain management in critically ill patients, ensuring adequate pain control and minimizing unnecessary use of analgesics. There are no specific exclusion criteria for its use, but it may be less accurate in patients with certain neurological conditions that affect facial expression or muscle tone.

Critical Care Pain Observation Tool (CPOT)

The Opioid Dose Conversion tool is designed to help users convert dosages between different types of opioids. Users provide two inputs by selecting the opioid type they are converting from and the type they want to convert to, each chosen from a preset list of options.

This tool operates using a predefined conversion factor table that relates each opioid type with one another. Depending on the "from" and "to" opioid selections, the tool computes a conversion factor indicating the equivalent dosage of the target opioid type necessary to achieve a therapeutic effect similar to the original opioid and dosage.

Here's a glance at how you can interpret these results and perform conversions:

- **Codeine to Other Opioids:**
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 1.15
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.0625
  - To Hydrocodone: Conversion factor is 0.15
  - Continue similarly for other drugs.

- **Fentanyl (buccal or sublingual) to Other Opioids:**
  - To Codeine: Conversion factor is 0.87
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.054
  - To Hydrocodone: Conversion factor is 0.13
  - Continue similarly for other drugs.

- **Fentanyl Transdermal to Other Opioids:**
  - To Codeine: Conversion factor is 16
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 18.5
  - To Hydrocodone: Conversion factor is 2.4
  - Continue similarly for other drugs.

- **Hydrocodone to Other Opioids:**
  - To Codeine: Conversion factor is 6.67
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 7.7
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.42
  - Continue similarly for other drugs.

- **Hydromorphone to Other Opioids:**
  - To Codeine: Conversion factor is 33.3
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 38.5
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 2.08
  - Continue similarly for other drugs.

- **Methadone to Other Opioids:**
  - To Codeine: Conversion factor is 31.33
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 36.15
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 1.96
  - Continue similarly for other drugs.

- **Morphine to Other Opioids:**
  - To Codeine: Conversion factor is 6.67
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 7.7
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.42
  - Continue similarly for other drugs.

- **Oxycodone to Other Opioids:**
  - To Codeine: Conversion factor is 10
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 11.54
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.625
  - Continue similarly for other drugs.

- **Oxymorphone to Other Opioids:**
  - To Codeine: Conversion factor is 20
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 23.1
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 1.25
  - Continue similarly for other drugs.

- **Tapentadol to Other Opioids:**
  - To Codeine: Conversion factor is 2.67
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 3.08
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.167
  - Continue similarly for other drugs.

- **Tramadol to Other Opioids:**
  - To Codeine: Conversion factor is 1.33
  - To Fentanyl buccal or sublingual (mcg): Conversion factor is 1.54
  - To Fentanyl transdermal (mcg/hr): Conversion factor is 0.083
  - Continue similarly for other drugs.

These conversion factors allow practitioners to translate dosages across different opioid medications accurately. The purpose of these conversions is to ensure patient safety and maintain equivalent analgesic effects when switching opioid drugs. Each conversion must be carefully considered alongside clinical judgment, as individual patient response may vary.

The Opioid Dose Conversion calculator, also known as the Opioid Equianalgesic calculator, is a tool used in the management of patients who are on opioid therapy for pain control. This calculator is used to convert the dose of one opioid to the equivalent dose of another opioid, allowing for safe and effective switching between different opioids. It is particularly useful in patients with chronic pain, cancer pain, or those undergoing palliative care. 

The calculator takes into account the potency of different opioids and the patient's current opioid dose to provide an equivalent dose of a different opioid. It is important to note that this calculator should not be used in opioid-naive patients, as it assumes a degree of opioid tolerance. Additionally, the calculator does not account for individual variations in opioid metabolism and response, so clinical judgment is still required in dose adjustments.

Postoperative pain

Guidelines

Key sources