Management of postoperative pain in children

Undertreatment of postoperative pain in children remains a problem. Reasons include lack of pain assessment, lack of knowledge about age-related physiological and pharmacological aspects, and fear of the side effects of opioids. When children need analgesics, it is important to choose a comfortable administration route of (no intramuscular injections!). Nonopioid analgesics such as acetaminophen are used after minor surgical procedures. The use of opioids requires individual dose titration and careful monitoring of side effects; they can be administered intravenously either as a continuous infusion or via a patient-controlled system. Nerve blocks applied intraoperatively provide good pain relief, and another option is epidural analgesia with local anesthetics and/or opioids. Adjuvant analgesics and nonpharmacologic interventions such as transcutaneous electrical nerve stimulation are used according to the underlying pain pathophysiology, primarily in patients suffering from neuropathic pain. The establishment of pain services and comprehensive education of both nursing and medical staff can help improve postoperative pain therapy in children.