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2015 ; 28
(5
): 570-6
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Pain after surgery in children: clinical recommendations
#MMPMID26280822
Walker SM
Curr Opin Anaesthesiol
2015[Oct]; 28
(5
): 570-6
PMID26280822
show ga
PURPOSE OF REVIEW: This article summarizes recent data related to the safety and
efficacy of postoperative analgesia in children that influence clinical practice
recommendations. RECENT FINDINGS: Postoperative pain continues to be experienced
by hospitalized children and following discharge after short stay or ambulatory
surgery. Updated recommendations for post-tonsillectomy analgesia exclude codeine
and suggest regular administration of paracetamol and NSAID, but evidence for the
most appropriate dose and type of opioid for rescue analgesia is limited. The
incidence of opioid-related respiratory depression/oversedation in hospitalized
children ranges from 0.11 to 0.41%, with recent large series identifying
high-risk groups and contributory factors that can be targeted to minimize the
risk of serious or permanent harm. Data demonstrating feasibility and safety of
regional analgesic techniques is increasing, but additional and
procedure-specific evidence would improve technique selection and inform
discussions of efficacy and safety with patients and families/carers. Persistent
postsurgical pain is increasingly recognized following major surgery in
adolescents. Evaluation of potential predictive factors in clinical studies and
investigation of underlying mechanisms in laboratory studies can identify targets
for both pharmacological and nonpharmacological interventions. SUMMARY:
Recommendations for postoperative pain in children continue to evolve, with data
incorporated from randomized controlled trials, case series and large audits.
Management of pain following surgery in children needs to not only encompass
efficacy and safety in the immediate perioperative period, but also consider pain
following discharge after ambulatory surgery and the potential risk of persistent
postsurgical pain following major surgery.
|Analgesics, Opioid/adverse effects/*therapeutic use
[MESH]
|Analgesics/adverse effects/*therapeutic use
[MESH]