Postoperative Pain Management in Children and Infants: An Update

Abstract

Many factors contribute to suboptimal pain management in children. Current evidence suggests that severe pain in children has significant long-lasting effects, even more so than in adults. In particular, recent evidence suggests a lack of optimal postoperative pain management in children, especially following ambulatory surgery. This review provides simple guidelines for the management of postoperative pain in children. It discusses the long-term effects of severe pain and how to evaluate pain in both healthy and neurologically impaired children, including neonates. Currently available treatment options are discussed with reference to the efficacy and side effects of opioid and non-opioid and regional analgesic techniques. The impact of preoperative anxiety on postoperative pain, and the efficacy of some nonpharmacological techniques such as hypnosis or distraction, are also discussed. Finally, basic organizational strategies are described, aiming to promote safer and more efficient postoperative pain management in children.

Pain relief in the palm of your hand: Harnessing mobile health to manage pediatric pain

“…Pediatric pain is a complex problem that requires a multimodal approach for effective management. Despite growing awareness of the importance of adequate pharmacological and multidisciplinary pain management, acute and chronic pain in children continues to be vastly undermanaged . There are many barriers to effective management of pain and one of the most salient is the shift of responsibility of pain management to the home setting where parents are often hesitant to use analgesics and healthcare providers have less direct involvement in the pain management process.…”

“…Despite growing awareness of the importance of adequate pharmacological and multidisciplinary pain management, 1 acute and chronic pain in children continues to be vastly undermanaged. 2 There are many barriers to effective management of pain and one of the most salient is the shift of responsibility of pain management to the home setting 3 where parents are often hesitant to use analgesics 4 and healthcare providers have less direct involvement in the pain management process. Thus, it is critical to find a way to address gaps in knowledge translation in order to improve the management of children's pain, particularly in the home setting.…”

Randomized controlled trial on preemptive analgesia for acute postoperative pain management in children

“…Postoperative pain management in infants and children is a challenge for pediatric anesthesiologists, despite the development of new drugs and techniques. Factors contributing to inadequate pain relief in pediatric patients are lack of training and experience, difficulties in quantifying pain, low expectations with respect to postoperative analgesia , inter‐patient variability in pain perception and analgesic requirements , and differences in pharmacodynamics and pharmacokinetics between infants and children . Inadequate postoperative pain control may lead to adverse outcomes, including chronic pain, increased health care costs, and decreased functioning and productivity .…”

“…Therefore, the need for active intervention by pediatric anesthesiologists in managing postoperative pain cannot be overemphasized. The agents most commonly used in pediatric postoperative pain control are opioids and nonopioid analgesics, including paracetamol, nonsteroidal anti‐inflammatory drugs (NSAIDs), tramadol, dexamethasone, and alpha 2 agonists . Opioids are usually given orally or intravenously on a per demand basis or through patient‐controlled analgesia (PCA) in pediatric patients.…”

Transversus Abdominis Plane Block to Alleviate Postoperative Pain in Children: A Meta-Analysis of Randomized Controlled Trials

“…Sufficient postoperative pain control in children is benefit for the surgical stress relief and postoperative recovery (3,4). Nowadays, multimodal pain management approaches including both pharmacological and non-pharmacological strategies have been applied to improve postoperative analgesia in children (5,6).…”