Good Practice in Postoperative and Procedural Pain Management ...

Section 2.0Executive Summary and Quick Reference GuideContents2.1 Introduction2.2 Pain assessment2.3 Medical procedures2.4 Procedural pain in the neonate: general recommendations2.5 Procedural pain in the neonate: specific recommendations2.6 Procedural pain in older children2.7 Postoperative pain2.1 IntroductionThis evidence-based guideline for the management ofpostoperative and procedural pain in children was developedby a multidisciplinary guideline development groupof the Association of Paediatric Anaesthetists of GreatBritain and Ireland with representation from consumers,the Royal College of Paediatrics and Child Health(RCPCH), the British Pain Society (BPS), the RoyalCollege of Nursing (RCN) and the Faculty of Pain Medicineof the Royal College of Anaesthetists (FPMRCA).The guideline was complied using methodology developedby the Scottish Intercollegiate Guideline Network(SIGN). Descriptions of levels of evidence, grading ofrecommendations and their associated symbols can befound in Section 1.0 and in the technical report, Appendix1, of the supplementary materials. The guideline wasdeveloped for the use of health professionals. It isintended to inform decision making in the managementof acute postoperative and procedural pain. This is thesecond edition of the guideline, it supersedes previousversions. The guideline will be updated every 5 years.The guideline comprises evidence-based ‘Recommendations’and ‘Good practice points’. Recommendations aregraded A–D according to the strength of evidence underpinningthem, the grading does not reflect the importanceof the recommendation. Good practice pointsindicate best practice according to the clinical experienceand opinion of the guideline development committee.Not all recommendations are included in this quickreference guide, common abbreviations and completedetails are available in the relevant sections of theguideline.2.2 Pain assessmentPain assessment and measurement of pain intensity arevital components of good pain management practice.Self-report of pain by children who are able to do so,observation of behaviors or physiological parameters thatare known to reflect pain intensity using a standardizedpain ‘measure’, ‘instrument’, or ‘tool’ are options. Toselect an appropriate method, the principles and limitationsof standardized pain measures must be understood.A simple guide to valid measures for postoperativeand procedural pain is given in Table 1. But pleasenote that reliance on chronological age as the soleindicator of a child’s capacity to self-report will inevitablygenerate both false positives (invalid scores fromTable 1 Recommended measures for procedural and postoperativepain assessment as a function of the child’s chronological ageChild’s age*MeasureNewborn–3 years oldCOMFORT or FLACC4 years old FPS-R + COMFORT or FLACC5–7 years old FPS-R7 years old + VAS or NRS or FPS-R*With normal or assumed normal cognitive developmentchildren who do not understand the scale) and falsenegatives (not obtaining valid scores from childrenwho do understand the scale but were not asked).Good practice pointsTo assess pain, effective communication should occurbetween the child whenever feasible, their family or carers,and the professionals in the multi-disciplinary team.Standardized instruments should be used in their finalvalidated form. Even minor modifications that alterthe psychometric properties of the tool may bias clinicalassessments and render comparison between studiesinvalid.4 ª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79