Paediatric pain management: from regional to virtual

Abstract

Purpose of reviewDue to increased interest in opioid-sparing multimodal analgesic strategies both inside and outside of the operating room, anaesthesiologists have started to look towards regional anaesthesia as well as nonpharmacological pain-reducing techniques. The purpose of this article is to discuss current trends and recent developments in regional anaesthesia and virtual reality for paediatric pain management.Recent findingsThe development of novel fascial plane blocks has expanded regional options for anaesthesiologists, especially when neuraxial anaesthesia is not a viable or straightforward option. Other regional techniques, such as spinal anaesthesia and continuous epidural analgesia for infants and neonates, are becoming more popular, as more paediatric anaesthesiologists become familiar with these techniques. Virtual reality for paediatric pain management is a relatively new area of study that has shown promise, but more research needs to be done before widespread adoption of this practice becomes a reality. Various preexisting pain-reducing strategies such as distraction and biofeedback are being integrated with virtual reality to help optimize its effect on pain and anxiety for paediatric patients.SummaryRegional anaesthesia and virtual reality are valuable tools that serve to alleviate pain in paediatric patients. Advances are being made within both fields in various healthcare settings for different types of pain. Over the next few years, they will likely both play an increasing role in paediatric pain management.

Pediatric regional anesthesiology: a narrative review and update on outcome-based advances

“…Improved multimodal efforts for analgesia, including topical anesthesia, neuromodulatory and thermomechanical devices for labs and intravenous access, sucrose and/or breastfeeding as an analgesic aid, comfort positioning, and age-appropriate distraction have shown to have benefits for minor procedures. In addition to multimodal pharmacologic approaches, nonpharmacologic modalities, such as physical therapy, occupational therapy, psychology, and psychiatry, and integrative therapies, such as acupuncture and massage, are very helpful in some patients 144–146 …”

“…In addition to multimodal pharmacologic approaches, nonpharmacologic modalities, such as physical therapy, occupational therapy, psychology, and psychiatry, and integrative therapies, such as acupuncture and massage, are very helpful in some patients. [144][145][146] Acute and chronic pain management in pediatric patients is dynamic and complex; dedicated pediatric pain services targeting a combination of acute, chronic, acute-on-chronic, procedural, or palliative pain needs are essential in centers with significant pediatric patient populations. In any center performing pediatric regional anesthesia, staff with expertise in risk stratification, block placement, catheter management, and pediatric-specific pain management should be present.…”

Pain Care Management in Rare Diseases

“…According to Collins (2023), in children with severe pain and disability, intensive interdisciplinary pain management might be required to improve pain and function [10]. Heydinger et al (2023) have reported that regional anesthesia and virtual reality are valuable tools that serve to relieve pain in children [11]. Lalloo et al have recently published an article that shows that Project ECHO ® (Project Extension for Community Healthcare Outcomes) is a feasible model for the virtual education of interprofessional healthcare providers in treating pediatric pain [12].…”