Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Abstract

The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis

“…It can effectively relieve pain intensity, extend the pain-free period, and reduce opioid consumption during the postoperative recovery of adults under general anesthesia [41]. However, no suggestions have been provided in the literature on dexmedetomidine use for reducing postoperative pain in children [40]. Our current findings suggested that dexmedetomidine reduces the number of patients requiring analgesia and the pain intensity among children undergoing strabismus surgery.…”

“…Children undergoing strabismus surgery constitute a very-high-risk group for postoperative pain. Because elevated postoperative pain is associated with EA occurrence, a European Society for Pediatric Anesthesiology Pain Committee guideline [40] suggests postoperative pain management for six frequently performed procedures in children, but not including pediatric strabismus surgery. Dexmedetomidine has analgesic properties and has been widely used in various surgeries in adults.…”

Prednisone for the Treatment of Acute Nonspecific Mesenteric Lymphadenitis

“…Meantime of abdominal pain before therapy in our patients was less than a week; however, the recovery time after treating with prednisone was 1.7 days. We were guided by recommendations of European Society for Paediatric Anaesthesiology that the target should be to achieve and maintain pain scores below the intervention threshold of 4 (on a 10-point scale) [16]. Clinically important differences in acute pain relief using patients' perception have an impact on which analgesic interventions are regarded useful.…”

Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children

“…In addition, the effective use of basic analgesics has a significant impact on reducing the use of opioids, 63,64 which are reserved for the intraoperative and early postoperative period, in conditions where adequate monitoring is provided and a continuous opioid infusion requires the availability of specially trained personnel 24 h a day. In 2018, the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee published guidelines 65 to improve postoperative pain management in children. Although these guidelines are primarily aimed at Europe, the authors of the guidelines hope that they can also be used in other countries around the world, and that postoperative pain therapy can be adapted based on the availability of medicines, national recommendations and drug registration rules in different countries.…”