Good Practice in Postoperative and Procedural Pain Management ...

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pressure and volume from the diffusion of nitrousoxide into closed air-containing cavities and is thereforecontraindicated in the presence of pneumothorax.Frequent side effects include euphoria,disinhibition, dizziness, dry mouth, and disorientation.Nausea and vomiting can occur. Excessive sedationis managed by discontinuation of the gas,oxygen administration, and basic airway management.Prolonged or frequent use may affect folate metabolismleading to megaloblastic changes in the bonemarrow, megaloblastic anemia, and peripheral neuropathy.Depression of white cell formation may alsooccur. Patients who receive N 2 O more frequentlythan twice every 4 days should have regular bloodcell examination for megaloblastic changes and neutrophilhypersegmentation.Exposure to prolonged high concentrations of N 2 Ohas been associated with reduced fertility in men andwomen. It should only be used in a well-ventilatedenvironment, which should be monitored and maintainedbelow the UK Occupational Exposure Standardfor atmospheric levels of N 2 O that is 37 2.0 ml maximumEach ‘dip’ of the pacifier is estimated to be 0.2 ml.The effectiveness of sucrose appears to decrease withage, at present it’s use as a primary analgesic shouldbe confined to the neonatal period until further informationis available.6.8.2 Sucrose side effects and toxicityCoughing, choking, gagging, and transient oxygen desaturationshave been reported; when using the syringemethod, the solution should be applied carefully to thetongue one drop at a time. There is some evidence thatadverse effects of sucrose, including a temporaryincrease in ‘Neurobiologic Risk’ score, is more frequentin very premature infants, particularly those
steps that health care professionals will perform); thesensations the patient can expect to feel (e.g., sharpscratch, numbness); and about how to cope with theprocedure.l Relaxation is a state of relative freedom from anxietyand skeletal muscle tension, a quieting or calmingof the mind and muscles.Further readingBNFC: The British National Formulary for Children,Vol. 2nd Edition. London: BMJ Publishing GroupLtd, 2012.References1 Morton NS. Ropivacaine in children. Br JAnaesth 2000; 85: 344–346.2 Berde C. Local anaesthetics in infants andchildren: an update. Pediatr Anesth 2004;14: 387–393.3 Bosenberg A. Pediatric regional anesthesiaupdate. Pediatr Anesth 2004; 14: 398–402.4 Mazoit J, Dalens B. Pharmacokinetics oflocal anaesthetics in infants and children.Clin Pharmacokinet 2004; 43: 17–32.5 Persson J. Wherefore ketamine? Curr OpinAnaesthesiol 2010; 23: 455–460.6 Dahmani S, Michelet D, Abback PS et al.Ketamine for perioperative pain managementin children: a meta-analysis of publishedstudies. Pediatr Anesth 2011; 21: 636–652.7 Basker S, Singh G, Jacob R. Clonidine inpaediatrics – a review. Indian J Anaesth2009; 53: 270–280.8 Schnabel A, Poepping DM, Kranke P et al.Efficacy and adverse effects of ketamine asan additive for paediatric caudal anaesthesia:a quantitative systematic review of randomizedcontrolled trials. Br J Anaesth2011; 107: 601–611.9 Engelman E, Marsala C. Bayesian enhancedmeta-analysis of post-operative analgesicefficacy of additives for caudal analgesia inchildren. Acta Anaesthesiol Scand 2012;Epub ahead of print.10 Kart T, Christrup L, Rasmussen M. Recommendeduse of morphine in neonates,infants and children based on a literaturereview: part 2 – clinical use. Paediatr Anaesth1997; 7: 93–101.11 Kart T, Christrup L, Rasmussen M. Recommendeduse of morphine in neonates,infants and children based on a literaturereview: part 1 – pharmacokinetics. PaediatrAnaesth 1997; 7: 5–11.12 Kalso E. Oxycodone. J Pain Symptom Manage2005; 29(Suppl): S47–S56.13 Grond S, Sablotzki A. Clinical pharmacologyof tramadol. Clin Pharmacokinet 2004;43: 879–923.14 Allegaert K, de Hoon J, Van Overmeire Bet al. Clinical pharmacology of non opioidanalgesics in neonates. Verh K Acad GeneeskdBelg 2005; 67: 289–315.15 Lesko S, Mitchell A. An assessment of thesafety of pediatric ibuprofen. A practitionerbasedrandomized clinical trial. JAMA1995; 273: 929–933.16 Anderson B, Anderson M, Hastie B. Paracetamolprescribing habits in a children’shospital. N Z Med J 1996; 109: 376–378.17 Anderson B. Acetaminophen analgesia ininfants. Anesth Analg 2001; 93: 1626–1627.18 Bruce E, Franck L. Self-administerednitrous oxide (Entonox) for the managementof procedural pain. Pediatr Nurs 2000; 12:15–19.19 Lefrak L, Burch K, Caravantes R et al.Sucrose analgesia: identifying potentiallybetter practices. Pediatrics 2006; 118(Suppl.2): S197–S202.20 Slater R, Cornelissen L, Fabrizi L et al.Oral sucrose as an analgesic drug for proceduralpain in newborn infants: a randomisedcontrolled trial. Lancet 2010; 376: 1225–1232.21 Bellieni C, Bagnoli F, Perrone S et al. Effectof multisensory stimulation on analgesia interm neonates: a randomized controlledtrial. Pediatr Res 2002; 51: 460–463.22 Cignacco E, Hamers JPH, Stoffel L et al.Routine procedures in NICUs: factors influencingpain assessment and ranking by painintensity. Swiss Med Wkly 2008; 138: 484–491.23 Uman LS, Chambers CT, McGrath PJ etal. Psychological interventions for needlerelatedprocedural pain and distress inchildren and adolescents. CochraneDatabase Syst Rev 2006; Oct 18;(4):CD005179.ª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79 79
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PediatricAnesthesiaVolume 22 Supple
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doi: 10.1111/j.1460-9592.2012.3838.
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1.6 Contact informationCorresponden
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RecommendationsChildren’s self-re
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Topical anesthetic preparations, fo
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2.7.6 Laparoscopic surgeryGood prac
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In order to assess pain, effective
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Postoperative painl NCCPC-PV (Non-C
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68 Broome ME, Richtsmeier A, Maikle
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however, reductions in the response
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increased success rate (i.e., less
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Newer preparations such as liposoma
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Good practice pointLubricant contai
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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
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: Table 6.6.1 Paracetamol dosing guid
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