Acute Paediatric Pain Management: A Practical Guide.

Abstract

Assistant Professor of Anesthesiology Wake Forest University School of Medicine Winston-Salem, North CarolinaAcute Paediatric Pain Management: A Practical Guide. Edited by Neil S. Morton. Philadelphia, Saunders, 1998. Pages: 296. List Price: $29.95.This book is edited by Neil S. Morton from the Department of Anaesthesia, Intensive Care, and Pain Management in the Royal Hospital for Sick Children at the University of Glasgow. All of the contributors are currently in practice in Europe, either Scotland or Denmark.The book is divided into 10 sections that include pain prevention and management, developmental pain, pain assessment, pharmacology of analgesics, local and regional anaesthesia, opioids, nonpharmacologic alternative techniques, sedation, and specific plans for pain management. At the end of each chapter, the key learning points are summarized in a list and highlighted. The book has no pictures and very few diagrams. Tables are used frequently, are easy to locate, and often contain important clinical information. A list for further reading concludes each chapter. The book has several appendices that contain examples of protocols and general information on specific techniques.The initial chapter is entitled, “Pain Prevention and Management,” but is really about the rationale for pain management and education. It is concise, with useful summary tables. The book continues with an adequate overview of the development of pediatric pain perception but does not incorporate this information into the clinical management of pain during development.The pain assessment section makes good use of tables. An excellent overview of the value of the different pain scales is provided, but it contains no description of the content of the actual scales themselves. However, the appendix does contain the more practical face scale, analog scale, and the poker chips scale.The book continues with a section on pharmacology of analgesics. This chapter is written at the basic level, with many sweeping generalizations and little or no explanation or discussion of the exceptions to the generalities.The local and regional, opioid, and nonopioid technique sections are better written. However, not all techniques are given the same attention, and some are only mentioned as possibilities. The local and regional section does not use enough tables and is further hampered by the lack of diagrams and pictures. The opioid section provides many tables, recipes, and protocols that are useful as guidelines with better references than elsewhere. Many different uses of the opioids are covered, with a good discussion of their side effects.The section on nonpharmacologic techniques is poorly developed. In addition, many of the alternative approaches to pain management, both pharmacologic and nonpharmacologic, are not mentioned.The sedation section is well written and contains good, sound information. Included are sample protocol sheets from the Royal Hospital for Sick Children. Numerous techniques are discussed with the focus on entonox, benzodiazepines, and opioids. Propofol is not mentioned, and the discussions of ketamine, barbiturates, and chloral hydrate are limited. The subsequent section on specific plans for pain prevention and control is a valuable addition; it outlines the concerns and considerations for many common pediatric procedures. This is a unique section and provides benefit for those learning about these procedures.In summary, the book provides a good overview of basic pain management in children. Specific referencing would have added to the scientific validity of several of the chapters. Objectives are clearly stated for each chapter, and tables are used liberally to enhance understanding and emphasize salient points. Overall, the book is well written and easy to understand. It is small, compact, and fits into the pocket of a laboratory coat. This book would be of most benefit to those interested in gaining a better understanding of pain and pain management in children from the anesthesiologist’s and perioperative physician’s perspective, particularly those in training in anesthesia and the surgical specialties.