BJA Advance Access originally published online on January 21, 2005
British Journal of Anaesthesia 2005 95(1):59-68; doi:10.1093/bja/aei065
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
REVIEW ARTICLE |
Postoperative analgesia in infants and children
1 Astrid Lindgrens Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. 2 University of Glasgow, Royal Hospital for Sick Children, Glasgow, Scotland, UK
* Corresponding author. E-mail: nsmorton@tiscali.co.uk
Keywords: analgesia, paediatric; analgesics; pain, acute; pain, postoperative
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Introduction |
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Over 20 yr ago, a survey reported that 40% of paediatric surgical patients experienced moderate or severe postoperative pain and that 75% had insufficient analgesia.106 Since then, a range of safe and effective techniques have been developed.
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Neonatal pain perception |
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The structural components necessary to perceive pain are already present at about 25 weeks gestation whereas the endogenous descending inhibitory pathways are not fully developed until mid-infancy.2 4 164 Opioid and other receptors are much more widely distributed in fetuses and neonates.52 53 62 66 127 Fetuses subjected to intrauterine exchange transfusion with needle transhepatic access will show both behavioural signs of pain as well as a hormonal stress response.64 Significant pain stimulation without proper analgesia, for example circumcision, will not only cause unacceptable pain at the time of the intervention but will produce a ‘pain memory’ as illustrated by an exaggerated pain response to vaccination as long as 6 months following the circumcision.148–150 Both neonates and infants are
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Successful postoperative pain management in infants and children |
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Local and regional anaesthesia |
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Benefits associated with the use of paediatric regional anaesthesia
Safety aspects of paediatric regional anaesthesia
Some simple local anaesthetic techniques for postoperative analgesia
Recent developments in regional analgesia
Spread of epidural dye
Confirming the tip position of catheters threaded from the sacral hiatus
Ultrasonography-guided regional anaesthetic techniques
Surface mapping of peripheral nerves with a nerve stimulator
Use of continuous peripheral nerve blocks
Choice of local anaesthetic solution
Adjuncts to local anaesthetics
Neuraxial blockade for paediatric cardiac surgery
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Systemic analgesia |
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Opioid techniques in children
Other methods of opioid delivery
Other opioids
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs and tonsillectomy
NSAIDs and asthma
NSAIDs and bone healing
COX-2 inhibitors in paediatrics
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Acetaminophen (paracetamol) |
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Conclusions |
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