Acute pain management in children: challenges and recent improvements
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Published on: March 28, 2025
Catherine E Ferland1,2,3,4,5,6, Eduardo Vega1,2,7, Pablo M Ingelmo1,2,4,5,6
1Department of Anesthesia, McGill University.
Insights
Effective pediatric postoperative pain management is challenging due to limited evidence. Multimodal approaches using nonopioid analgesics can reduce opioid reliance and prevent long-term complications.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Limited evidence exists for effective postoperative pain treatment in children.
- Opioid analgesics are common but carry risks of perioperative complications.
- Interpatient variability in pain necessitates better management strategies.
Purpose of the Study:
- To review initiatives for effective pediatric postoperative pain management.
- To focus on minimizing opioid use and preventing long-term pain consequences.
- To address the lack of evidence-based guidance for opioid prescription in children.
Main Methods:
- Review of current literature on pediatric postoperative pain management.
- Analysis of multimodal analgesic approaches.
- Evaluation of regional anesthetic techniques.
Main Results:
- Postoperative pain management often relies on protocols or trial-and-error, leading to undertreatment or overtreatment.
- Evidence-based guidelines for pediatric opioid use, especially post-discharge, are scarce.
- Multimodal strategies combining nonopioid analgesics can decrease opioid necessity and associated risks.
Conclusions:
- Treatment options are evolving, incorporating multimodal regimens and regional anesthesia.
- Nonopioid analgesic combinations offer a promising approach to limit opioid dependence.
- Further research is needed to identify children at higher risk for poor pain management.
Purpose Of Review:
The evidence regarding the efficacy of analgesics available to guide postoperative pain treatment in pediatric patients is limited. Opioid medications are very often an important component of pediatric postoperative pain treatment but have been associated with perioperative complications. We will focus on initiatives aiming to provide effective treatment minimizing the use of opioids and preventing the long-term consequences of pain.
Recent Findings:
Interpatient variability in postoperative pain is currently managed by applying protocols or by trial and error, thus often leading to patients being either undertreated or overtreated. Few evidence-based reports are available to guide the use of opioid medications in children, including the prescription of opioids after hospital discharge. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids, thus decreasing the risk of toxicity and dose-related side effects. There is a lack of adequate research in this field, and more specifically on identifying which patient is at higher risk of poor postoperative pain management.
Summary:
Treatment options have evolved in recent years, including the combinations of multimodal regimens and regional anesthetic techniques. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids.
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