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THE INFLUENCE OF THE USE MEDICAL CLOWNS TO THE REDUCTION OF
PREOPERATIVE ANXIETY, POSTOPERATIVE PAIN AND MEDICAL COSTS IN
CHILDREN UNDERGOING OUTPATIENT PENILE SURGERY: A RANDOMIZED
CONTROLLED TRIAL.
Michal DARMON, Genady LEV, Stanislav KOCHEROV, Yudit GABAY and Boris CHERTIN
Shaare Zedek Medical Center, Pediatric Urology, Jerusalem, ISRAEL
PURPOSE
We aimed to investigate prospectively the potential benefits of the participation of the medical clowns in the outpatient
pediatric penile surgery.
MATERIAL AND METHODS
We have randomly divided 80 children ageing from 2 to 16 years into two groups (40 each) who underwent meatotomy
utilizing an identical clinical setup. In the first group the medical clown was an integral part of the medical team and in
the second group the treatment was given without participation of the medical clown. We have recorded the following
parameters: the level of preoperative anxiety utilizing Modified Yale Preoperative Anxiety Scale Instrument, the level of
the postoperative pain utilizing FLACC Wong pain scores, need in pain rescue during first 24 hours after surgery and the
time needed to return to normal activities.
RESULTS
The patients from the first group demonstrated lower anxiety index upon (p=0.0319) and after surgery (p=0.0042),
required less induction time for anesthesia (p<0.001), spent overall less time in the operating room (p<0.0001) and
required less time to recover from the surgery and to be discharged (p=0.0172). The majority of health professionals
agreed with the presence of clowns in the operating theater (96.43%), considering them useful for the children
(96.4%), for the parents (89.3%), and for themselves (78.3%). The majority of the parents 78(97.5%) favored
continuing this type of intervention and 2(2.5%) thought that clowns are disturbing agents.
CONCLUSIONS
Use of the medical clown allows reducing children preoperative anxiety and shortage the overall time in the hospital
therefore potentially may reduce an overall medical cost.