[Pain treatment in neonates, infants and children--is the current treatment sufficient?]

Paediatric patients quite often have to undergo painful or stressful procedures, e. g. blood sampling, dressing of wounds or removal of a drainage. The key problem is to decide if a child has pain or if there are other reasons for crying. Establishing a high standard in an institution requires regular evaluation and documentation of pain scores. For many clinical situations, clear and functioning concepts exist - we just have to use them. Unanswered questions are the evaluation of pain in small children, the side-effects of opioids, surgery involving the airways and the risk-benefit-ratio of certain techniques. Pain therapy after tonsillectomy is still troublesome: relevant postoperative pain occurs. Local infiltration of the tonsillar bed has no pre-emptive effect and only a minimal impact on the postoperative pain. Management relies on opioids, steroids and non-opioids. Non-steroidal anti-inflammatory drugs should not be used because of an increased risk of bleeding. Promising data have been reported on COX-2-blockers, but experience in children is still limited. Pain management after circumcision is relatively easy to perform. A conduction block with a long-acting local anaesthetic combined with one dose of a non-steroidal anti-inflammatory drug provides sufficient analgesia in over (2/3) of patients. Today, penile block is the standard of care and complications only rarely occur. However, despite successful pain prevention, circumcision remains a stressful procedure for the small patients. Pain treatment per se is not sufficient to relieve all the suffering connected with surgery in children. The concept of balanced analgesia is successful under many circumstances, but continuous efforts are needed to improve the management for difficult situations, e. g. tonsillectomy.