Pain management in children

Stinson J, Naser B. Pain management in children with sickle cell disease. Paediatr Drugs 2003 5 229-238. 

Leith, P.J. and Weisman, S.J. (1997) Pharmacologic interventions for pain management in children. Child Adolesc Psychiatr Clin North Am 6 797-816. 

Rusy, L.M., Troshynski, T.J., and Weisman, J. (2001) Gabapentin in phantom limb pain management in children and young adults report of seven cases. / Pain Symptom Manage 21 78—82. 

The use of opioids in very young patients is increasing. In a review of pain management in children, various routes of administration of opioids and their associated adverse effects have been discussed (SEDA-17, 78). Attention has been drawn to the adverse effects of intravenous codeine in children and to the risk of convulsions with pethidine in neonates, because of accumulation of its metabolite norpethidine. The risk of respiratory depression with morphine was also highlighted, and morphine is recommended for use only in neonates who are being ventilated or intensively nursed. Routine use of pulse oximetry has been recommended in all children receiving opioids (SEDA-21, 86). 

In a web-based national survey of pain management in children, serious adverse events were associated with intravenous patient-controlled analgesia, with a response rate of 41% (294 of 724 practitioners) [59. Patient deaths and administration of naloxone to counteract cardiopulmonary adverse reactions were reported by 42 respondents. 

Pain management in infants and children Cardiopulmonary resuscitation in infants and children... 

The myth that neonates and young children do not experience pain has led to inadequate pain management in this population. 

TABLE 21-5 Modified from Agency for Health Care Policy and Research. Acute Pain Management in Infants, Children, and Adolescents Operative and Medical Procedures. No. 92-0020. U.S. Dept, of Health and Human Services,... 

Pfefferbaum, B. and Hagberg, C.A. (1993) Pharmacological management of pain in children. / Am Acad Child Adolesc Psychiatry 32 235-242. 

Richtsmeier, A.J., Barkin, R.L., and Alexander, M. (1992) Benzodiazepines for acute pain in children. / Pain Sympt Manage 7 492-495. 

Shannon, M. and Berde, C.B. (1989) Pharmacologic management of pain in children and adolescents. Pediatr Clin North Am 36 855-871. 

Clinical use The indications for levobupivacaine include wound infiltration (0.25 % solution), nerve conduction block (0.25 - 0.5 %), spinal analgesia (0.5 %) and epidural anesthesia (0.5 to 0.75 %). For labour analgesia, lower concentrations of levobupivacaine are recommended when administered as epidural injection (0.125 to 0.25 % up to 25 mg) or infusion (0.25 %). The maximum dose for ilioinguinal or iliohypogastric block in children is 1.25 mg/kg/side (0.25 to 0.5 % solutions). For postoperative pain management, levobupivacaine can be applied epidurally in combination with the opioids fentanyl or morphine or with the a2-agonist clonidine. 

Therapy for sickle cell disease has changed dramatically since the mid-1990s. Prior to the 1980s therapeutic interventions for sickle cell disease consisted of supportive care during acute illness, opioids for pain management, and occasional transfusions for severe anemia or life-threatening complications. At that time, sickle cell disease was considered a pediatric disease as there were few children who survived into adulthood. In 1986, the Penicillin Prophylaxis Study was conducted, providing evidence that early intervention with penicillin prevented... 

Waters L. Pharmacologic strategies for managing pain in children. Orthop Nurs 1992 11 34-40. 

While being devoid of myelosuppressive effects, tretinoin therapy is associated with headache, skin and mucous membrane reactions, bone pain, nausea, and the retinoic acid syndrome. When tretinoin is started, rapid onset of differentiation of promyelocytes occurs, which can lead to leukocytosis and/or retinoic acid syndrome. The retinoic acid syndrome (fever, respiratory distress, interstitial pulmonary infiltrates, pleural effusions, and weight gain) is now referred to as the APL differentiation syndrome or APL hyperleukocytosis syndrome, because it has been associated with other treatment modalities in the management of APL. Among tretinoin-treated patients, this syndrome has been fatal in 5% to 29% of cases. A combination of chemotherapy with tretinoin induction decreases the incidence of retinoic acid syndrome, and rapid initiation of dex-amethasone 10 mg (0.2 mg/kg per dose in children) twice daily for 3 days upon development of symptoms decreases associated mortality. 

Opioids remain the mainstay of pain treatment. Useful guidelines for their administration have been developed for a number of clinical situations, including treatment of acute pain, trauma, cancer, nonmalignant chronic pain, and pain in children. In the case of cancer pain, adherence to standardized protocols can improve pain management significantly. Guidelines for the oral and parenteral dosing of opioids are presented in Table 21-5. 

Off-label use Certain psychiatric disorders including bipolar disorders and post-traumatic stress disorder, non-neuritic pain syndromes, restless leg syndrome, management of alcohol, cocaine and benzodiazepine withdrawal, and chorea in children. ... 

Partin JC, Hamill SK, Fischel JEet al (1992) Painful defecation and faecal soiling in children. Pediatrics 89 1007-1009 Pena A (1993) Management of anorectal malformations in the new-born period. World J Surg 17 385-392 Powell RW, Raffensperger JG (1982) Congenital colonic atresia. J Pediatr Surg 17 166... 

Fowler-Kerry S, Lander JR (1987) Management of injection pain in children. Pain 30 169-175 French GM, Painter EC, Coury DL (1994) Blowing away shot pain a technique for pain management during immunization. Pediatrics 93 384-388... 

Brunet BR, Barnes AJ, Choo RE, Mura P, Jones HE, Huestis MA. A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen and hydro-codone for the management of postoperative pain in children after tonsillectomy. Clin J Pain 2010 26 95-103. 

Tobias JD. Weak analgesics and nonsteroidal antiinflammatory agents in the management of children with acute pain. Pediatr Clin North Am 2000 47(3) 527-543. 

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