Good Practice in Postoperative and Procedural Pain Management ...

doi: 10.1111/j.1460-9592.2012.3838.xSection 1.0Background1.1 IntroductionThis guidance was originally commissioned by theAssociation of Paediatric Anaesthetists of Great Britainand Ireland (APA). It is intended to be used byprofessionals involved in the acute care of childrenundergoing pain management after surgery or forpainful medical procedures. It is designed to provideevidence-based information on the efficacy of analgesicstrategies such that an informed choice of analgesicsthat are appropriate for the patient and clinical settingcan be made. The document includes advice on theassessment of pain, a summary of current evidence forthe efficacy of analgesic strategies, including evidencebasedrecommendations grouped according to namedprocedures, and a resume of analgesic pharmacology.This is the second edition of the guidelines – it was lastpublished in 2008.1.2 Guideline development committee1.3 Use, scope, and intentionThis guidance was developed by a committee of healthprofessionals with the assistance of a patient representative.It was published following a period of open publicconsultation, including advice from representativesfrom patient groups and professional organisations. Itis intended for use by qualified heath professionals whoare involved in the management of acute pain in children.In its present form, it is not suitable for use byother groups. At the present time, and largely becauseof resource limitations, no consumer guide is planned toenable the recommendations to be easily interpreted bythose who do not already possess knowledge and trainingin the field of children’s acute pain management.The guidance is relevant to the management of children0–18 years undergoing surgery or painful proceduresin hospital settings. It includes recommendationsfor pain assessment, general principles of pain management,and advice on the use of pharmacological andnonpharmacological pain management strategies forspecific medical and surgical procedures.Richard Howard Pediatric AnesthetistPain medicine specialistChairBernadette Carter Professor of Children’s NursingRepresenting RCNJoe Curry Pediatric SurgeonRepresenting BAPSAnoo Jain NeonatologistRepresenting RCPCHChristina Liossi Pediatric PsychologistSenior Lecturer in Health PsychologyNeil Morton Pediatric AnesthetistPain medicine specialistKate Rivett Lay RepresentativeMary Rose Pediatric AnesthetistPain medicine specialist, Representing BPSJennifer Tyrrell PediatricianRepresenting RCPCHSuellen Walker Pediatric AnesthetistSenior Lecturer in Pain MedicineGlyn Williams Pediatric AnesthetistPain medicine specialistProceduresThe procedures are divided into two categories, painfuldiagnostic and therapeutic (Medical procedures; Section4) and surgical procedures (Postoperative pain;Section 5). Guidance covers the management of acutepain during medical procedures and after surgery. Itdoes not include advice on the intraoperative managementof pain unless it is relevant to postoperative managementor is otherwise stated, for example, the use ofperioperative nerve blocks.The procedures that have been included are notexhaustive and were selected by the committee becausethey are relatively commonplace and, or, because it wasexpected that there would be sufficient publications toallow recommendations to be made on the basis of anadequate level of evidence. For each procedure, there isa brief description, list of recommendations, and ‘goodpractice points’ followed by a discussion of the relevantpublished evidence including Evidence tables (see below)summarizing the level of evidence available for the efficacyindividual analgesic strategies.ª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79 1