Pain relief for the pediatric surgical patient

Modern techniques available for the relief of pain following major surgical procedures or trauma in childhood receive scant attention in pediatric surgical textbooks. A range of options for pain relief have been offered to children in our hospital, which include: regional analgesia; appropriate use of intermittent intramuscular narcotic injections; and variable-rate intravenous narcotic infusions. Since 1982 regional analgesia has been used in more than 2,000 patients following operations on the penis and in the inguinoscrotal region. Two hundred forty five children with fractured femora have been managed using femoral nerve blocks. Intermittent intramuscular narcotic injections are the most common method of pain relief. However, the variable nature of children's pain frequently results in an unsatisfactory outcome. Variable-rate intravenous narcotic infusions were introduced in 1982 and the first 155 infusions in 144 patients have been analyzed. The protocol and method of administration are described along with the dosage and problems encountered during the introduction of the technique. It has now been employed postoperatively in 242 more patients and many infusions have been commenced in the emergency department, intensive care, and neonatal units bringing the total number of infusions to more than 600. Assessment of effective pain relief has been made on the basis of observation and comment by parents and patients and by medical and nursing staff. The steady increase in demand for the use of this technique is an index of its value. It is concluded that there is a real need to improve pain relief for children by better education of medical and nursing staff and inclusion of this important subject in pediatric surgical text books.