Good Practice in Postoperative and Procedural Pain Management ...

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172 van Twillert B, Bremer M, Faber AW.Computer-generated virtual reality to controlpain and anxiety in pediatric and adultburn patients during wound dressingchanges. J Burn Care Res 2007; 28: 694–702.173 Sharar SR, Carrougher GJ, Nakamura D etal. Factors influencing the efficacy of virtualreality distraction analgesia during postburnphysical therapy: preliminary results from 3ongoing studies. Arch Phys Med Rehabil2007; 88: S43–S49.174 Glat PM, Kubat WD, Hsu JF et al. Randomizedclinical study of SilvaSorb gel incomparison to Silvadene silver sulfadiazinecream in the management of partial-thicknessburns. J Burn Care Res 2009; 30: 262–267.175 Saba SC, Tsai R, Glat P. Clinical evaluationcomparing the efficacy of aquacel ag hydrofiberdressing versus petrolatum gauze withantibiotic ointment in partial-thicknessburns in a pediatric burn center. J BurnCare Res 2009; 30: 380–385.176 Kargi E, Tekerekoglu B. Usage of lidocaine-prilocainecream in the treatment ofpostburn pain in pediatric patients. UlusTravma Acil Cerrahi Derg 2010; 16: 229–232.177 Ozil C, Vialle R, Thevenin-Lemoine C et al.Use of a combined oxygen/nitrous oxide/morphine chlorydrate protocol for analgesiain burned children requiring painful localcare. Pediatr Surg Int 2010; 26: 263–267.178 Brochard S, Blajan V, Lempereur M et al.Effectiveness of nitrous oxide and analgesiccream (lidocaine and prilocaine) for preventionof pain during intramuscular botulinumtoxin injections in children. Ann Phys RehabilMed 2009; 52: 704–716.32 ª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79
Section 5.0Postoperative painContents5.1 General principles of postoperative pain management5.2 ENT surgery5.2.1 Myringotomy5.2.2 Tonsillectomy5.2.3 Mastoid and middle ear surgery5.3 Opthalmology5.3.1 Strabismus surgery5.3.2 Vitreoretinal surgery5.4 Dental procedures5.5 General surgery and urology (minor and Intermediate)5.5.1 Sub-umbilical surgery5.5.2 Circumcision5.5.3 Neonatal circumcision5.5.4 Hypospadias repair5.5.5 Orchidopexy5.5.6 Open inguinal hernia repair5.5.7 Umbilical hernia repair5.6 General surgery and urology (major)5.6.1 Intra-abdominal surgery5.6.2 Appendicectomy (open)5.6.3 Fundoplication (open)5.6.4 Major urology5.7 Laparoscopic surgery5.8 Orthopaedics, spinal and plastic surgery5.8.1 Lower limb surgery5.8.2 Upper limb surgery5.8.3 Spinal surgery5.8.4 Cleft lip and palate and related procedures5.9 Cardiothoracic surgery5.9.1 Cardiac surgery (sternotomy)5.9.2 Thoracotomy5.10 Neurosurgery5.10.1 Craniotomy and major neurosurgery5.1 General principles of postoperativepain managementGood practice pointsProviders of postoperative care should understand thegeneral principles of good pain management in children;this includes knowledge of assessment techniquesand the use of analgesics at different developmentalages.Pediatric anesthetists are responsible for initiatingpostoperative analgesia. They should liaise withpatients and their families/carers, surgeons, and othermembers of the team providing postoperative care toensure that pain is assessed and suitable ongoinganalgesia is administered.Postoperative analgesia should be appropriate todevelopmental age, surgical procedure, and clinicalsetting to provide safe, sufficiently potent, and flexiblepain relief with a low incidence of side effects.Combinations of analgesics should be used unlessthere are specific contra-indications, for example;local anesthetics, opioids, NSAIDs, and paracetamolcan be given in conjunction, not exceeding maximumrecommended doses.IntroductionPostoperative care is frequently shared between heathprofessionals from different disciplines: they should besuitably qualified, including an awareness of the generalprinciples of pain assessment and pain managementin children. Postoperative analgesia should beplanned and organised prior to surgery in consultationwith patients and their families or carers, and othermembers of the perioperative team. The pediatric anesthetistis responsible for initiating suitable postoperativeanalgesia; this should be considered to be part ofthe overall plan of anesthesia.Analgesia is an integral part of surgical anesthesia,and therefore, potent analgesics are administered duringgeneral anesthesia in the form of opioids, localanesthetics, and other drugs. Patients and carersshould be made aware that the effects of these analgesicswill wear off in the postoperative period, leadingto an increase in pain and the need for further analgesia.Patients should not be discharged from the PostoperativeCare Unit (postanesthesia recovery area)until satisfactory pain control is established and ongoinganalgesia is available.Prior to discharge from the hospital, patients andtheir families should be given clearly presented informationand advice regarding the assessment of painand the administration of analgesia at home. It is alsoª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79 33
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 18 and 19: 68 Broome ME, Richtsmeier A, Maikle
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 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
Page 68 and 69: Section 6.0AnalgesiaContents6.1 Ana
Page 70 and 71: enhance systemic absorption. Lidoca
Page 73 and 74: undergoes hepatic biotransformation
Page 75 and 76: tein binding are reduced and the ha
Page 77 and 78: a low-dose infusion but the child m
Page 79 and 80: Table 6.6.1 Paracetamol dosing guid
Page 81: steps that health care professional

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