Good Practice in Postoperative and Procedural Pain Management ...

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Section 4.0Medical ProceduresContents4.1 General considerations4.2 Procedural pain in the neonate4.2.1 Blood sampling4.2.2 Ocular examination for retinopathy of prematurity4.2.3 Lumbar puncture4.2.4 Urine sampling4.2.5 Chest drain (tube) insertion and removal (see 4.3.3)4.2.6 Nasogastric tube placement (see 4.3.5)4.2.7 Immunization and intramuscular injection4.3 Procedural pain in infants and older children4.3.1 Blood sampling and intravenous cannulation4.3.2 Lumbar puncture4.3.3 Chest drain (tube) insertion and removal4.3.4 Bladder catheterization and urine sampling procedures4.3.5 Insertion of nasogastric tubes4.3.6 Immunization and intramuscular injection4.3.7 Repair of lacerations4.3.8 Change of dressings in children with burns4.3.9 Botulinum injections for children with muscle spasm4.1 General considerationsRoutine medical care involving blood sampling andother painful diagnostic and therapeutic procedurescan cause great distress for children and their families.When such procedures are essential, it is importantthat they should be achieved with as little pain as possible.For many children who have chronic illness,these procedures often need to be repeated, and thiscan generate very high levels of anxiety and distress iftheir previous experience has been poor. The 10 generalprinciples, which apply to the management of allprocedures at any age, are listed below. Further advicefor use in specific age-groups, and specifically for someof the most common procedures, is described in sections4.2 and 4.3.1. Infants and children of all ages, including prematureneonates, are capable of feeling pain and require analgesiafor painful procedures.2. Developmental differences in the response to painand analgesic efficacy should be considered whenplanning analgesia.3. Consider whether the planned procedure is necessary,and how the information it will provide mightinfluence care? Avoid multiple procedures if possible.4. Plan the timing of procedures to minimize the frequencyof a painful procedure.5. Are sedation or even general anesthesia likely to berequired for a safe and satisfactory outcome?6. Would modification of the procedure reduce pain?For example, venepuncture is less painful than heellance.7. Is the planned environment suitable? Ideally, thisshould be a quiet, calm place with suitable toys anddistractions.8. Ensure that appropriate personnel who possess thenecessary skills are available, and enlist experiencedhelp when necessary.9. Allow sufficient time for analgesic drugs and otheranalgesic measures to be effective.10. Formulate a clear plan of action should the procedurefail or pain become unmanageable using the techniquesselected.Good practice pointPain management for procedures should include bothpharmacological and nonpharmacological strategieswhenever possible.4.2 Procedural pain in the neonatePremature neonates are able to perceive pain, but theresponse to both pain and analgesia is dependant ondevelopmental age. Because of this, pain assessment inthis age-group is particularly difficult (see section 3),and the low sensitivity of many pain measurementtools can complicate the interpretation of evidence.Clinically, neonates appear to be sensitive to theadverse effects of many drugs, including analgesics;ª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79 17
Page 1 and 2: PediatricAnesthesiaVolume 22 Supple
Page 3 and 4: doi: 10.1111/j.1460-9592.2012.3838.
Page 5 and 6: 1.6 Contact informationCorresponden
Page 7 and 8: RecommendationsChildren’s self-re
Page 9 and 10: Topical anesthetic preparations, fo
Page 11 and 12: 2.7.6 Laparoscopic surgeryGood prac
Page 13 and 14: In order to assess pain, effective
Page 16 and 17: Postoperative painl NCCPC-PV (Non-C
Page 20 and 21: however, reductions in the response
Page 22 and 23: increased success rate (i.e., less
Page 24 and 25: Newer preparations such as liposoma
Page 26 and 27: Good practice pointLubricant contai
Page 28 and 29: most effective. There are a number
Page 30 and 31: 12 Bellieni C, Bagnoli F, Perrone S
Page 32 and 33: venipuncture pain in a pediatric em
Page 34 and 35: 172 van Twillert B, Bremer M, Faber
Page 36 and 37: necessary to ensure that the patien
Page 38 and 39: when compared with LA alone and sal
Page 40 and 41: Peribulbar block improves early ana
Page 42 and 43: Analgesia Table 5.5.1 Sub-umbilical
Page 44 and 45: was more effective with less motor
Page 46 and 47: with using landmark techniques (205
Page 48 and 49: Good practice pointWound infiltrati
Page 50 and 51: Analgesia Table 5.6.4 Urological Su
Page 52 and 53: (298). Ketorolac did not influence
Page 54 and 55: well as the epidural technique for
Page 56 and 57: Good practice pointA multi-modal an
Page 58 and 59: 14 Grainger J, Saravanappa N. Local
Page 60 and 61: day-stay unit. Int J Paediatr Dent
Page 62 and 63: tinuous epidural infusion in childr
Page 64 and 65: 245 Morton NS, O’Brien K. Analges
Page 66 and 67: 321 Taenzer AH, Clark C, Taenzer AH
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Section 6.0AnalgesiaContents6.1 Ana
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enhance systemic absorption. Lidoca
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undergoes hepatic biotransformation
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tein binding are reduced and the ha
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a low-dose infusion but the child m
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Table 6.6.1 Paracetamol dosing guid
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steps that health care professional
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