Related Experiment Video
Updated: May 2, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
[Pediatric perioperative systemic pain therapy: Austrian interdisciplinary recommendations on pediatric perioperative
B Messerer1, G Grögl, W Stromer
1Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, LKH-Universitätsklinikum Graz, Auenbruggerplatz 29, 8036, Graz, Österreich, brigitte.messerer@medunigraz.at.
Insights
Pediatric pain management relies on non-opioids like NSAIDs for mild to moderate pain, with opioids used for severe cases. Ketamine serves as an adjuvant for sedation and analgesia in children.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Pediatric pain management faces challenges due to limited licensed analgesics.
- Current guidelines emphasize pain intensity for treatment selection.
- Intramuscular and subcutaneous injections are generally avoided in children.
Framework:
- Non-opioids, particularly non-steroidal anti-inflammatory drugs (NSAIDs), form the basis of systemic pain therapy for children.
- NSAIDs are recommended prophylactically and are more effective than paracetamol for acute pain, potentially reducing opioid use.
- Considerations for NSAID use include hepatic/renal function and coagulation status; paracetamol use requires careful indication due to potential asthma links.
Implementation:
- Opioids are indicated for moderate to severe pain when non-opioids are insufficient, suitable for all pediatric age groups.
- Titrated opioid administration based on effectiveness is crucial.
- Patient-controlled anesthesia with continuous monitoring is recommended for severe pain exceeding 24 hours.
Implications:
- Ketamine is a valuable adjuvant for postoperative pain management and pediatric sedation/analgosedation.
- Safe pediatric pain management requires careful consideration of drug choice, dosage, duration, and patient-specific factors.
- Optimizing pediatric pain therapy ensures adequate relief while minimizing risks.
Background:
Many analgesics used in adult medicine are not licensed for pediatric use. Licensing limitations do not, however, justify that children are deprived of a sufficient pain therapy particularly in perioperative pain therapy. The treatment is principally oriented to the strength of the pain. Due to the degree of pain caused, intramuscular and subcutaneous injections should be avoided generally.
Non-Opioids:
The basis of systemic pain therapy for children are non-opioids and primarily non-steroidal anti-inflammatory drugs (NSAIDs). They should be used prophylactically. The NSAIDs are clearly more effective than paracetamol for acute posttraumatic and postoperative pain and additionally allow economization of opioids. Severe side effects are rare in children but administration should be carefully considered especially in cases of hepatic and renal dysfunction or coagulation disorders. Paracetamol should only be taken in pregnancy and by children when there are appropriate indications because a possible causal connection with bronchial asthma exists. To ensure a safe dosing the age, body weight, duration of therapy, maximum daily dose and dosing intervals must be taken into account. Dipyrone is used in children for treatment of visceral pain and cholic. According to the current state of knowledge the rare but severe side effect of agranulocytosis does not justify a general rejection for short-term perioperative administration.
Opioids:
In cases of insufficient analgesia with non-opioid analgesics, the complementary use of opioids is also appropriate for children of all age groups. They are the medication of choice for episodes of medium to strong pain and are administered in a titrated form oriented to effectiveness. If severe pain is expected to last for more than 24 h, patient-controlled anesthesia should be implemented but requires a comprehensive surveillance by nursing personnel.
Ketamine:
Ketamine is used as an adjuvant in postoperative pain therapy and is recommended for use in pediatric sedation and analgosedation.
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