Management of postoperative pain in children

Treatment of pain. Undertreatment of postoperative pain in children is a pr oblem in clinical practice. This is due to a lack of both knowledge about a ge-specific aspects of physiology and pharmacology, and routine pain assess ment. For example, the fear of side-effects prevents the adequate usage of opioids. It is of major importance to select a route of drug administration where the child feels comfortable with (avoid intramuscular injections). N on-opioid analgesics. Non-opioid analgesics are recommended for basic pain treatment after minor surgical procedures. Instead of using the whole multitude of drugs availabl e, the doctor should stick to those drugs he is familiar with (acetaminophe n, ibuprofen, diclofenac, dipyrone). Opioids. Opioid usage requires individual dose titration and careful monito ring of side-effects (respiratory monitoring, sedation score). The strong o pioids piritramide and morphine may advantageously be administered as eithe r continuous, or patient-controlled iv- infusion (PCA). Forms of therapy. In addition to infiltration anesthesia, intraoperatively applied nerve blocks provide excellent pain relief. Epidural analgesia with local anesthetics and/or opioids via a thoracic or lumbar epidural cathete r is a therapeutic option after thoracic or abdominal surgery, or after ext ensive orthopedic or urological interventions. Adjuvant analgesics and nonp harmacologic interventions, i.e. transcutaneous electrical nerve stimulatio n (TENS),are primarily indicated in patients suffering from neuropathic pai n. Conclusion. The establishment of pain services and the comprehensive educat ion of both the nursing and the medical staff should help to improve postop erative pediatric pain therapy.