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Management of postoperative pain in children
  1. N S Morton
  1. For correspondence:
    Neil S Morton
    Consultant in Paediatric Anaesthesia & Pain Management, Royal Hospital for Sick Children, Glasgow G3 8SJ, Scotland, UK; nsmorton{at}tiscali.co.uk

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To manage postoperative pain safely and effectively in children, the principles listed below are helpful. The aims are to recognise pain in children, to minimise moderate and severe pain safely in all children, to prevent pain where it is predictable, to bring pain rapidly under control, and to continue pain control after discharge from hospital.1–3

  • Individualised, child centred approach

  • Holistic care of emotional and physical components of pain

  • Informed consent from parent and child about options, risks and benefits

  • Use least invasive effective technique for level of pain anticipated

  • Match technique to complexity of surgery/procedure

  • Adjust technique for age, medical status and co-morbidity

  • Use child-friendly formulations and delivery methods

  • Ensure a safe environment and appropriate monitoring

  • Ensure staff have appropriate training, experience and on-going practice

TECHNIQUES FOR MANAGEMENT OF POSTOPERATIVE PAIN IN CHILDREN

Prevention of pain has been shown to work well for nearly all cases and can be adapted for day cases, major cases, the critically ill child, or the very young. Techniques of concurrent or co-analgesia are based on four classes of analgesics: local anaesthetics, opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen). In particular, a local/regional analgesic technique should be used in all cases unless there is a specific reason not to, and the opioid-sparing effects of local anaesthetics, NSAIDs and paracetamol are useful.4,5

A pain management plan can be made for each child adjusted over time by a cycle of assessment and documentation of the child’s pain using appropriate tools and self-reporting, with interventions linked to the assessments.6 A safety net is needed for rapid control of breakthrough pain, to monitor the efficacy of analgesia, to identify and treat adverse effects, and to ensure that equipment is functioning correctly.2

Pain is difficult to measure precisely and reliably in children, and many pain measurement tools and scores have been …

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