MANAGEMENT OF POSTOPERATIVE PAIN IN CHILD REN

Postoperative pain in children is not receiving adequate attention. Ma jor reasons for this ,,undertreatment'' is an unsatisfactory knowledge of physiological and pharmacological aspects. In addition, there is a lso a lack of awareness of the problem of postoperative pain in the pa ediatric patient. These shortcomings must be countered by further educ ation and the measurement of pain in operated children. Children, too, have a right to benefit from the wide range of pain-alleviating measu res available. In addition to topical anaesthesia, nerve blocks applie d intra-operatively are particularly suitable for use in children. Whe n analgesics are employed, a child-friendly mode of application should be given preference (no i.m. injection). In every case, the individua l dose required should be established by intravenous titration. When o pioids are employed (continuous or patient controlled), monitoring of the respiration is required. The use of epidural analgesia with topica l analgesics or opioids can be considered for thoraco-abdominal extens ive orthopaedic and urological procedures. In the case of amputations, analgesia using an epidural catheter is also to be recommended. Coana lgesics and stimulative procedures (TENS) are matched to the pathophys iological causes of pain.Greater use of pulse oximeters, the provision of rooms for the newly operated patient, and the establishment of pai n services that offer a tightly organised further education programme for nursing and medical staff will help improve the management of pain in paediatric patients.