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Pain relief for the pediatric surgical patient
Insights
Effective pain management for children undergoing surgery or trauma requires better education and textbook inclusion. Variable-rate intravenous narcotic infusions offer a valuable, increasingly demanded option for pediatric pain relief.
Area of Science:
- Pediatric Surgery
- Pain Management
- Anesthesiology
Background:
- Pediatric surgical textbooks inadequately cover modern pain relief techniques.
- Children's pain management often relies on intermittent intramuscular narcotic injections, yielding unsatisfactory results.
- Advanced pain relief options are available but underutilized.
Purpose of the Study:
- To evaluate the effectiveness and implementation of variable-rate intravenous narcotic infusions for pediatric pain.
- To highlight the need for improved pain management education in pediatric surgery.
- To advocate for the inclusion of pain relief strategies in pediatric surgical literature.
Main Methods:
- Analysis of 155 initial variable-rate intravenous narcotic infusions in 144 pediatric patients.
- Description of the protocol, administration, dosage, and challenges of the infusion technique.
- Review of over 600 infusions used postoperatively and in emergency, intensive care, and neonatal units.
Main Results:
- Regional analgesia used in over 2,000 patients for urogenital surgeries and 245 for femur fractures.
- Variable-rate intravenous narcotic infusions introduced in 1982, with increasing demand.
- Pain relief assessed via patient, parent, and staff observations, indicating positive outcomes.
Conclusions:
- Variable-rate intravenous narcotic infusions are a valuable technique for pediatric pain management.
- There is a significant need for enhanced education for medical and nursing staff on pediatric pain relief.
- Pediatric surgical textbooks must incorporate comprehensive information on advanced pain management strategies.
Abstract:
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.