Pediatric Pain and Postoperative Management

Abstract

Both assessment and management of pain in children present challenges for perioperative physicians, including surgeons, anesthesiologists, intensivists, and pediatricians, among others. Several reports have indicated that pediatric pain is undertreated postoperatively compared with pain in adults, resulting in both severe physical consequences, such as the development of chronic pain and complex regional pain syndromes, and significant psychological distress, such as nightmares and reversal of learned behavior. Moreover, chronic pain in childhood has been shown to heighten the risk for mental health problems in adulthood. Children with chronic pain (n = 14,790) reported higher rates of lifetime anxiety disorders (21.1% versus 12.4%) and depressive disorders (24.5% vs 14.1%) as adults. Although many evidence-based practice guidelines for pain management in younger people have been developed, adherence is often less than complete. The perioperative physician should be aware of barriers in pediatric pain management and be able to address them, thus improving pain management and patient outcome. Some of the problems in dealing with pediatric pain management include a realization of the controversies as to the age at which children feel pain, how pain can be assessed from the newborn to the adolescent, how the level of education and involvement of parents impact the situation, and a general knowledge of available pain treatments for the pediatric population. Key words: complications, opioids, pediatrics, postoperative pain, regional techniques