Postoperative Pain in Children (Literature Review)
More than 80 % of patients, who undergo surgical procedures, experience acute postoperative pain, and approximately 75% of those with postoperative pain report the severity as moderate, severe, or extreme. Evidence suggests that less than half of patients, who undergo surgery, report adequate postoperative pain relief. Inadequately controlled pain negatively affects quality of life, function, and functional recovery, the risk of post-surgical complications, and the risk of persistent postsurgical pain. We have analyzed a number of European and American guidelines regarding pain in children to select the most effective approaches to the treatment of postoperative pain in them. Children’s pain should be assessed. Effective pain assessment is essential both in terms of its contribution to the prevention and relief of a child’s pain and also in its role as a diagnostic aid. The centrality of pain assessment to high-quality pain management is considered in many current pain management recommendations, position statements, reports, and guidelines. Assessment refers to a broad endeavor aiming to identify the factors that shape the pain experience including physiological, cognitive, affective, behavioral and contextual, and their dynamic interactions. The guidelines recommend that clinicians provide patient- and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for management of postoperative pain, and document the plan and goals for postoperative pain management. The guidelines recommend that clinicians offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with non-pharmacological interventions, for the treatment of postoperative pain in children and adults (strong recommendation, high-quality evidence). Multimodal analgesia, defined as the use of a variety of analgesic medication and techniques that target different mechanisms of action in the peripheral and/or central nervous system (which might also be combined with non-pharmacological interventions), might have additive or synergistic effects and more effective pain relief compared with single-modality interventions. For example, clinicians might offer local anesthetic-based regional (peripheral and neuraxial) analgesic techniques in combination with systemic opioids and other analgesics as a part of a multimodal approach to perioperative pain. Because of the availability of effective non-opioid analgesics and non-pharmacologic therapies for postoperative pain management, the panel suggests that clinicians routinely incorporate around the clock non-opioid analgesics and non-pharmacologic therapies into multimodal analgesia regimens. Systemic opioids might not be required in all patients. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for the treatment of mild or moderate pain in children. In addition to analgesia, they have anti-inflammatory and antipyretic effects. They are opioid-sparing. The combination of NSAIDs and paracetamol produces better analgesia than either drug alone. Their mechanism of action is the inhibition of cyclooxygenase activity, thereby blocking the synthesis of prostaglandins and thromboxane. Aspirin, a related compound, is not used in children because of the potential to cause Reye syndrome. Paracetamol is a weak analgesic. On its own, it can be used to treat mild pain; in combination with NSAIDs or a weak opioid, such as codeine, it can be used to treat moderate pain. Studies have demonstrated an opioid-sparing effect, when it is administered postoperatively.
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Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged // Anesth Analg. 2003; 97: 534-540. PMID: 12873949.
Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of postsurgical pain: Results from a US national survey // Curr Med Res Opin. 2014; 30: 149-160. DOI: 10.1185/03007995.2013.860019.
Guidelines on the Management of Postoperative Pain Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council // J Pain. 2016 Feb; 17(2): 131-57. DOI: 10.1016/j.jpain.2015.12.008.
Kehlet H, Jensen T, Woolf C. Persistent postsurgical pain: Risk factors and prevention // Lancet. 2006; 367: 1618-1625. DOI: 10.1016/S0140-6736(06)68700-X.
WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. p. 37. http: //apps.who.int/medicinedocs/documents/s19116en/s19116en. pdf. (Accessed on July 07, 2013).
Good practice in postoperative and procedural pain management, 2nd edition // Paediatr Anaesth. 2012; 22 Suppl 1: 1-79. DOI: 10.1111/j.1460-9592.2012.03838.x.
Huth MM, Broome ME, Mussatto KA, Morgan SW. A study of the effectiveness of a pain management education booklet for parents of children having cardiac surgery // Pain Manage. Nurs. 2003; 4: 31-39. DOI: http://dx.doi.org/ 10.1053/jpmn.2003.7.
Cheng SF, Foster RL, Hester NO. A review of factors predicting children’s pain experiences // Issues Compr Pediatr Nurs. 2003; 26: 203-216. Available from: http://dx.doi.org/ 10.1080/01460860390246678.
Grond S, Sablotzki A. Clinical pharmacology of tramadol // Clin Pharmacokinet. 2004; 43: 879-923. PMID: 15509185.
Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in childrenwith cognitive impairment // Anesth Analg. 2002; 95: 1224-1229. DOI: 10.1097/00000539-200211000-00020.
Von Baeyer CL, Spagrud L. Systematic review of observational (behavioral) measures of pain in children and adolescentsaged 3 to 18 years // Pain. 2007; 127: 140-150. http://dx.doi.org/10.1016/j.pain.2006.08.014.
Elia N, Lysakowski C, Tramer MR. Does multimodal analgesia with acetaminophen, nonsteroidal anti-inflammatory drugs, or selective cyclooxygenase-2 inhibitors and patientcontrolled analgesia morphine offer advantages over morphine alone? // Anesthesiology. 2005; 103: 1296-1304. PMID: 16306743.
Ruetzler K, Blome C, Nabecker S, Makarova N, Fischer H, Rinoesl H, Goliasch G, Sessler D, Koinig H. A randomized trial of oral versus intravenous opioids for treatment of pain after cardiac surgery // J Anesth. 2014; 28: 580-586. DOI: 10.1007/s00540-013-1770-x.
Ruggiero A, Barone G, Liotti L, Chiaretti A, Lazzareschi I, Riccardi R. Safety and efficacy of fentanyl administered by patient controlled analgesia in children with cancer pain // Support Care Cancer. 2007; 15: 569-573. DOI: 10.1007/s00520-006-0193-8.
Jarzyna D, Jungquist CR, Pasero C, Willens JS, Nisbet A, Oakes L, Dempsey SJ, Santangelo D, Polomano RC. American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression // Pain Manag Nurs. 2011; 12: 118-145. DOI: 10.1016/j.pmn.2011.06.008.
McNicol ED, Tzortzoloulou A, Cepeda MS, Francia MB, Farhat T, Schumann R. Single-dose intravenous paracetamol or propacetamol for prevention or treatment of postoperative pain: A systematic review and meta-analysis // Br J Anaesth. 2011; 106: 764-775. DOI: 10.1093/bja/aer107.
Dahmani S, Michelet D, Abback PS et al. Ketamine for perioperative pain management in children: a meta-analysis of published studies // Pediatr Anesth. 2011; 21: 636-652. DOI: 10.1111/j.1460-9592.2011.03566.x.
De Oliveira GS, Duncan K, Fitzgerald P, Nader A, Gould RW, McCarthy RJ. Systemic lidocaine to improve quality of recovery after laparoscopic bariatric surgery: A randomized double-blinded placebo-controlled trial // Obes Surg. 2014; 24 : 212-218. DOI: 10.1007/s11695-013-1077-x.
Krishna S, Hughes L, Lin S. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a metaanalysis // Arch Otolaryngol Head Neck Surg. 2003; 129: 1086-1089. DOI: 10.1001/archotol.129.10.1086.
Morris B, Watts P, Zatman T et al. Pain relief for strabismus surgery in children: a randomised controlled study of the use of preoperative sub-Tenon levobupivacaine // Br J Ophthalmol. 2009; 93: 329-332. DOI: 10.1136/bjo.2008.145268.
Fredrickson MJ, Paine C, Hamill J. Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after pediatric inguinal surgery: a prospective randomized trial // Paediatr Anaesth. 2010; 20: 1022-1027. DOI: 10.1111/j.1460-9592.2010.03432.x.
Ponde VC. Continuous infraclavicular brachial plexus block: a modified technique to better secure catheter position in infants and children // Anesth Analg. 2008; 106: 94-96. DOI: 10.1213/01.ane.0000289633.81407.65.
Blumenthal S, Min K, Nadig M et al. Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery // Anesthesiology. 2005; 102: 175-180. PMID: 15618801.
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