Blocks and other techniques pediatric surgeons can employ to reduce postoperative pain in pediatric patients.

Abstract

Painful experiences, such as circumcision without the benefit of anesthesia, during the neonatal period may induce lifelong behavior changes in infants and children. By inference, this is probably true for other painful experiences encountered during childhood. It is much easier to prevent the establishment of pain than it is to eradicate it once it has become firmly established. As "captain of the ship," there are three very basic things a pediatric surgeon can do to reduce postoperative discomfort in your young patients. First, whenever possible, allow caudal blocks or other forms of regional anesthesia, such as penile or ilioinguinal-iliohypogastric nerve blocks, to be performed on your patients. Second, always use timed analgesics and avoid PRN orders. Last, know how to use two analgesics well, one narcotic and one non-narcotic. Be completely familiar with their uptake, distribution, and elimination half-lives. This article presents a review of the efficacy and safety of caudal blocks, and the use of ilioinguinal/iliohypogastric, "splash," and penile blocks as alternative techniques for providing perineal analgesia. In addition, the most current and efficacious dosage regimen for the rectal administration of acetaminophen (40.0 mg/kg after induction of anesthesia, then 20.0 mg/kg every 6 hours for the first 24 postoperative hours) is presented. Additionally, the novel use of intravenous methadone (0.2 to 0.3 mg/kg) to provide intense and protracted narcotic analgesia is discussed.