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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