MANAGEMENT OF POSTOPERATIVE PAIN IN CHILDREN

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