Pediatric pain management: Clinical aspects for the nineties

Abstract

No patient should be denied safe and effective postoperative analgesia. The well-informed pain management specialist has the opportunity to dramatically alter the perioperative pain experience of children undergoing medical procedures and surgery by making pain treatment a priority. This includes dispelling the misconception among anesthesiologist, surgeon, and nurse colleagues that pain is unimportant in the very young and that its treatment is unnecessary and unsafe. There are a variety of new and refined techniques that allow the pain management specialist to individualize the analgesic therapy based on the nature of the surgery, the patient's underlying medical condition and expectations, and the anesthesiologist's training and experience. Several regional anesthesia techniques provide safe and effective analgesia for the ambulatory pediatric patient. The availability of trained pain-management staff members 24 hours a day enables patients to receive safe and effective analgesia by means of epidural catheters or PCA. Both opioid and nonopioid agents may be used as an alternatives or supplements to regional anesthesia techniques. Psychological methods of pain relief for children and adolescents are not as widely used and understood as they might be. Both pleasant imagery and progressive muscle relaxation have been shown to decrease self-reported pain intensity and pain distress. Pain management in children and adolescents seems best addressed with an integrated multidisciplinary approach that begins in the postoperative period or initial acute phase of injury and extends through the patient's convalescence period. Hopefully, this article will enable health care providers to make more educated decisions about analgesic use and, particularly, about the need for opioid narcotics in the pediatric patient. Also, health care providers must be made more aware of the dimensions and safeness of regional anesthesia/analgesic techniques.