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Advances and Technical Standards in Neurosurgery pp 225–271Cite as

Prevention and Treatment of Postoperative Pain with Particular Reference to Children

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Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 30))

Abstract

Pain therapy is an important aspect of medical practice for patients of all ages, to optimize care, to obtain an adequate quality of life and to improve their general conditions. Pain is among the most prevalent symptoms experienced by patients undergoing surgery. The success of postoperative pain therapy depends on the ability of the clinician to assess the presenting problems, identify and evaluate pain syndromes and formulate a plan for comprehensive continuing care. The prevalence of acute pain has led to the need to develop techniques for the assessment and management of this symptom in order to focus the attention on an interdisciplinary therapeutic approach (including pharmacologic, cognitivebehavioral, psychologic and physical treatment) and on the timing of different interventions (pre and postoperative). In this chapter we describe the principal therapeutic approaches to control pain in post-operative patients, such as non-opioid, opioid and adjuvant analgesics with particular attention in paediatric age. Moreover we report the principal scales to assess the pain intensity in the post-operative period. The need of a multidisciplinatory team and of a pre and postoperative pain management program represents an important goal in order to obtain effective pain relief and optimize pediatric care and rapid recovery. The introduction of a perioperative team service will improve the approach to pain management programs and it is considered the most important challenge for future.

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References

  1. American Academy of Pediatrics, American Pain Society (2001) The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 108: 793–797

    Google Scholar 

  2. Schechter NL, Blankon V, Pachter LM et al (1999) The ouchless place: no pain, children’s gain. Pediatrics 99: 890–894

    Google Scholar 

  3. Zacharias M, Watts D (1998) Pain relief in children. BMJ 316: 1552

    CAS  PubMed  Google Scholar 

  4. McGrath PA (1991) Assessment of pain in children. In: Bond MR, Charlton JE, Woolf CJ (eds) Proceedings of the VIth World Congress on Pain. Elsevier, Amsterdam

    Google Scholar 

  5. Wall PD, Melzack R (1999) Textbook of pain, 4th edn

    Google Scholar 

  6. Craig KD, Whitfield MF, Grunau RV, Linton J, Hadjistavropoulos HD (1993) Pain in the preterm neonate: behavioural and physiological indices. Pain 52: 287–299

    CAS  PubMed  Google Scholar 

  7. Cote JJ, Morse JM, James SG (1991) The pain response of the postoperative newborn. J Adv Nurs 16: 378–387

    CAS  PubMed  Google Scholar 

  8. McGrath PA (1995) Pain in the pediatric patient: practical aspects of assessment. Pediatr Ann 24:126–133, 137–138

    CAS  PubMed  Google Scholar 

  9. Beyer JE, McGrath PJ, Berde CB (1990) Discordance between self-report and behavioral pain measures in children aged 3–7 years after surgery. J Pain Symptom Management 5: 350–356

    CAS  Google Scholar 

  10. Fuller BF, Conner DA (1995) The effects of pain on infant behaviours. Clin Nurs Res 4: 253–273

    CAS  PubMed  Google Scholar 

  11. McGrath PJ (1998) Behavioural measures of pain. In: McGrath PJ (ed) IASP Press Measurement of Pain in Infants and Children. Seattle

    Google Scholar 

  12. Romsing J, Hertel S, Moller-Sonnergaard J, Rasmussen M (1996) Postoperative pain in children: comparison between ratings of children and nurses. J Pain Symptom Management 11: 42–46

    CAS  Google Scholar 

  13. Romsing J, Walther-Larsen S (1996) Postoperative pain in children: a survey of parents’ expectations and perceptions of their children’s experiences. Paediatr Anaesth 6: 215–218

    CAS  PubMed  Google Scholar 

  14. Ambuel B, Hamlett KW, Marx CM, Blumer JL (1992) Assessing distress in pediatric intensive care environments: the COMFORT Scale. J Pediatr Psychol 17: 95–109

    CAS  PubMed  Google Scholar 

  15. Van Dijk M, de Boer JB, Koot HM, Tibboel D et al (2000) The reliability and validity of the Comfort scale as a postoperative pain instrument in 0 to 3 years-old infants. Pain 84: 367–377

    PubMed  Google Scholar 

  16. Norden J, Hannallah RS, Getson P, O’Donnell R, Kelliher G, Walker N (1991) Concurrent validation of an objective pain scale for infants and children. Anesthesiology 75: 312–316

    Google Scholar 

  17. Norden J, Hannallah RS, Getson P, O’Donnell R, Kelliher G, Walker N (1991) Reliability of an objective pain scale in children. Anesth Analgesia 72: S199

    Google Scholar 

  18. Myron AD, Yaster FA (2000) Acute pain in children. Pediatr Clin North Am 47: 22–26

    Google Scholar 

  19. Tyler DC, Tu A (1993) Toward validation of pain measurement tools for children: a pilot study. Pain 52: 301–309

    CAS  PubMed  Google Scholar 

  20. Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB (1990) The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain 41:139–150

    CAS  PubMed  Google Scholar 

  21. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B (2001) The Faces Pain Scale revised: toward a common metric in pediatric pain measurement. Pain 93:173–183

    CAS  PubMed  Google Scholar 

  22. Chambers CT, Giesbrecht K, Craaig KD, Bennett SM, Huntsman E (1999) A comparison of facial scales for measurement of pediatric pain: children’s and parents’ ratings. Pain 83: 25–35

    CAS  PubMed  Google Scholar 

  23. Hain RDW (1997) Pain scales in children: a review. Palliative Med 11: 341–350 24.

    CAS  Google Scholar 

  24. Tanube P (1995) Recognising pain as a component of the primary assessment; adding D for discomfort to the ABCs. J Emerg Nurs 21: 299–304

    PubMed  Google Scholar 

  25. WHO (1998) Cancer pain relief and palliative care in children

    Google Scholar 

  26. Breivik H (2001) Opioids in cancer and chronic non-cancer pain therapy-indications and controversies. Acta Anaest Scand 45:1059–1066

    CAS  Google Scholar 

  27. Chiaretti A, Viola L, Pietrini D, Piastra M et al (2000) Preemptive analgesia with tramadol and fentanyl in pediatric neurosurgery. Child’s Nerv Syst 16: 93–100

    CAS  Google Scholar 

  28. Møiniche S (2002) A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief. The role of timing of analgesia. Anesthesiology 96: 725–741

    PubMed  Google Scholar 

  29. McQuay HJ (1995) Preemptive analgesia: a systematic review of clinical studies. Ann Med 27: 249–258

    CAS  PubMed  Google Scholar 

  30. Berry FA (1998) Preemptive analgesia for postoperative pain. Paediatr Anaesth 8:187–188

    CAS  PubMed  Google Scholar 

  31. Feldman D, Reich N, Foster JM (1998) Pediatric anesthesia and postoperative analgesia. Pediatr Clin North Am 45: 1525–1537

    CAS  PubMed  Google Scholar 

  32. Maxwell LG, Yaster M (2000) Perioperative management issues in pediatric patients. Anesth Clin North Am 18: 601–632

    CAS  Google Scholar 

  33. Collins SL, Edwards JE, Moore RA, McQuay HJ (2003) Single dose dextropropoxyphene, alone and with paracetamol (acetaminophen), for postoperative pain (Cochrane review). In: The Cochrane Library, Issue 2. Oxford

    Google Scholar 

  34. Moore A, Collins S, Carroll D, McQuay H, Edwards J (2003) Single dose paracetamol (acetaminophen), with and without codeine, for postoperative pain (Cochrane review). In: The Cochrane Library, Issue 2. Oxford

    Google Scholar 

  35. Collins SL, Moore RA, McQuay HJ, Wiffen PJ, Edwards JE (2003) Single dose oral ibuprofen and diclofenac for postoperative pain (Cochrane review). In: The Cochrane Library, Issue 2. Oxford

    Google Scholar 

  36. 36. Collins SL (2003) Nonsteroidal anti-inflammatory drugs for postoperative pain: a focus on children. Paediatr Drugs 5:103–123

    PubMed  Google Scholar 

  37. Chambliss CR, Anand KJ (1997) Pain management in the pediatric intensive care unit. Curr Opin Pediatr 9: 246–253

    CAS  PubMed  Google Scholar 

  38. Hyllestead RA (2002) Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 88: 199–214

    PubMed  Google Scholar 

  39. Kost-Byerly S (2001) Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs 3: 817–858

    PubMed  Google Scholar 

  40. Litalien C, Jacqz-Aigrain E (2002) New concepts in acute and extended postoperative pain management in children. Anesth Clin North Am 20: 115–135

    Google Scholar 

  41. Camu F, Van de Velde A, Vanlersberghe C (2001) Nonsteroidal anti-inflammatory drugs and paracetamol in children. Acta Anaesth Belg 52: 13–20

    CAS  PubMed  Google Scholar 

  42. Sutters KA, Shaw BA, Gerardi JA, Hebert D (1999) Comparison of morphine patient-controlled analgesia with and without ketorolac for postoperative analgesia in pediatric orthopedic surgery. Am J Orthop 28: 351–358

    CAS  PubMed  Google Scholar 

  43. Vetter TR, Heiner EJ (1994) Intravenous ketorolac as an adjuvant to pediatric patient-controlled analgesia with morphine. J Clin Anesth 6: 110–113

    CAS  PubMed  Google Scholar 

  44. Mantzke US, Brambrink AM (2002) Paracetamol in childhood. Current state of knowledge and indications for a rational approach to postoperative analgesia Anaesthesist 51:735–746

    CAS  Google Scholar 

  45. Lieh-Lai MW, Kauffman RE, Uy HG et al (1999) A randomized comparison of ketorolac tromethamine and morphine for postoperative analgesia in critically ill children. Crit Care Med 27: 2786–2791

    CAS  PubMed  Google Scholar 

  46. Anderson B (1998) What we don’t know about ketorolac in children. Paediatr Anaesth 8: 451–460

    CAS  PubMed  Google Scholar 

  47. Forrest JB (1997) Ketorolac for postoperative pain management in children. Drug Safety 16: 309–329

    CAS  PubMed  Google Scholar 

  48. Harley EH, Dattolo RA (1998) Ibuprofen for tonsillectomy pain in children: efficacy and complications. Otolaryngol Head Neck Surg 119: 492–496

    CAS  PubMed  Google Scholar 

  49. Autret-Leca E (2003) General overview of the use of ibuprofen in paediatrics. Int J Clin Pract [Suppl] 135: 9–12

    CAS  Google Scholar 

  50. Chiaretti A, Simeone E, Langer A, Butera G et al (1997) Analgesic efficacy of ketorolac and fentanyl in pediatric intensive care. Pediatr Med Chir 19: 419–424

    CAS  PubMed  Google Scholar 

  51. Moiniche S, Romsing J, Dahl JB, Tramer MR (2003) Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review. Anesth Analg 96: 68–67

    CAS  PubMed  Google Scholar 

  52. Rusy LM, Houck CS, Sullivan LJ et al (1995) A double-blind evaluation of ketorolac tromethamine versus acethaminophen in pediatric tonsillectomy: analgesia and bleeding. Anesth Analg 80: 226–229

    CAS  PubMed  Google Scholar 

  53. Lesko SM, Mitchell AA (1999) The safety of acetaminophen and ibuprofen among children younger than two years old. Pediatrics 104: 952

    Google Scholar 

  54. Wolfe MM (1999) Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. NEJM 340: 1888–1899

    CAS  PubMed  Google Scholar 

  55. Lee A (1999) The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function: a meta-analysis. Anaesth Intensive Care 27: 574–580

    CAS  PubMed  Google Scholar 

  56. Mandell BF (1999) COX 2-selective NSAIDs: biology, promises, and concerns. Cleve Clin J Med 66: 285–292

    CAS  PubMed  Google Scholar 

  57. Brookes P (1999) Interpreting the clinical significance of the differential inhibition of cyclooxygenase-1 and cyclooxygenase-2. Brit J Rheumatol 38: 779–787

    Google Scholar 

  58. Stichtenoth DO, Frolich JC (2003) The second generation of COX-2 inhibitors: what advantages do the newest offer? Drugs 63: 33–45

    CAS  PubMed  Google Scholar 

  59. Kiefer W, Dannhardt G (2002) COX-2 inhibition and the control of pain. Curr Opin Investig Drugs 3: 1348–1358

    CAS  PubMed  Google Scholar 

  60. Katz WA (2002) Cyclooxygenase-2-selective inhibitors in the management of acute and perioperative pain. Cleve Clin J Med 69: SI65–SI75

    PubMed  Google Scholar 

  61. Cochrane DJ, Jarvis B, Keating GM (2002) Etoricoxib. Drugs 62: 2637–2651

    CAS  PubMed  Google Scholar 

  62. Morrison BW (1999) Analgesic efficacy of the cyclooxygenase-2-specific inhibitor rofecoxib in post-dental durgery pain: a randomized, controlled trial. Clin Therapeutics 21: 943–953

    CAS  Google Scholar 

  63. Malmstrom K (1999) Comparison of rofecoxib and celecoxib, two cyclooxygenase-2 inhibitors, in postoperative dental pain: a randomized, placebo and active comparitor controlled clinical trial. Clin Therapeutics 21: 1653–1663

    CAS  Google Scholar 

  64. Barden J, Edwards JE, McQuay HJ, Moore RA (2003) Single dose oral celecoxib for postoperative pain (Cochrane review). In: The Cochrane Library, Issue 2. Oxford

    Google Scholar 

  65. Ruoff G, Lema M (2003) Strategies in pain management: new and potential indications for COX-2 specific inhibitors. J Pain Symptom Management 25: S21–31

    CAS  Google Scholar 

  66. Pickering AE, Bridge HS, Nolan J, Stoddart PA (2002) Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children. Br J Anaesth 88: 72–77

    CAS  PubMed  Google Scholar 

  67. Kart T, Christrup LL, Rassmussen M (1997) Recomanded use of morphine in neonates, infants and children based on literature review. 1. Pharmacokinetics. Paediatr Anaesth 7: 5–11

    CAS  PubMed  Google Scholar 

  68. Pounder DR, Steward DJ (1992) Postoperative analgesia: opioids infusion in infants and children. Can J Anaesth 39: 969–974

    CAS  PubMed  Google Scholar 

  69. Jin F, Chung F (2001) Multimodal analgesia for postoperative pain control. J Clin Anesth 13: 524–539

    CAS  PubMed  Google Scholar 

  70. Morton NS (1993) Development of a monitoring protocol for the safe use of opioids in children. Paediatr Anaesthesia 3: 179–184

    Google Scholar 

  71. Kart T, Christrup LL, Rasmussen M (1997) Recommended use of morphine in neonates, infants and children based on a literature review: part 2. Clinical use. Paediatr Anaesth 7:93–101

    CAS  PubMed  Google Scholar 

  72. William DG, Hatch DJ, Howard RF (2001) Codeine phosphate in paediatric medicine. Br J Anaesth 86: 413–421

    CAS  PubMed  Google Scholar 

  73. Lehmann KA (1994) Tramadol for the management of acute pain. Drugs 47: 19–32

    Google Scholar 

  74. Viitanen H, Annila P (2001) Analgesic efficacy of tramadol 2 mg kg (−1) for paediatric day-case adenoidectomy. Br J Anaesth 86: 572–575

    CAS  PubMed  Google Scholar 

  75. Finkel JC, Rose JB, Schmitz ML et al (2002) An evaluation of the efficacy and tolerability of oral tramadol hydrochloride tablets for the treatment of postsurgical pain in children. Anesth Analg 94: 1469–1473

    CAS  PubMed  Google Scholar 

  76. Berde CB, Sethna NF (2002) Analgesics for the treatment of pain in children. New Engl J Med 347: 1094–1103

    CAS  PubMed  Google Scholar 

  77. Holder KA, Dougherty TB, Porche VH, Chiang JS (1998) Postoperative pain management. Int Anesthesiol Clin 36:71–86

    CAS  PubMed  Google Scholar 

  78. Mukherjee K, Esuvaranathan V, Streets C, Johnson A, Carr AS (2001) Adenotonsillectomy in children: a comparison of morphine and fentanyl for perioperative analgesia. Anaesthesia 56:1193–1197

    CAS  PubMed  Google Scholar 

  79. Kiffer F, Joly A, Wodey E, Carre P, Ecoffey C (2001) The effect of preoperative epidural morphine on postoperative analgesia in children. Anesth Analg 93: 598–600

    CAS  PubMed  Google Scholar 

  80. Tobias JD, Deshpande JK, Wetzel RC, Facker J, Maxwell LG, Solca M (1990) Postoperative analgesia. Use of intrathecal morphine in children. Clin Pediatr (Phila) 29: 44–48

    CAS  Google Scholar 

  81. Yee LY, Lopez JR (1992) Transdermal fentanyl. Ann Pharmacother 26: 1393–1399

    CAS  PubMed  Google Scholar 

  82. Van Dijk M, Bouwmeester NJ, Duivenvoorden HJ, Koot HM et al (2002) Efficacy of continuous versus intermittent morphine administration after major surgery in 0-3-year-old infants; a double-blind randomized controlled trial. Pain 98: 305–313

    PubMed  Google Scholar 

  83. Esmail Z, Montgomery C, Court C et al (1999) Efficacy and complications of morphine infusions in postoperative paediatric patients. Paediatr Anaesth 9: 321–327

    CAS  PubMed  Google Scholar 

  84. Hendrickson M, Myre L (1990) Postoperative analgesia in children: a prospective study in intermittent intramuscolar injiection versus continuous intravenous infusion of morphine. J Pediatr Surg 25: 185–190

    CAS  Google Scholar 

  85. McDonald AJ, Cooper MG (2001) Patient-controlled analgesia: an appropriate method of pain control in children. Paediatr Drugs 3: 273–284

    CAS  PubMed  Google Scholar 

  86. Ballantyne JC, Carr DB, Chalmers TC, Dear KBG et al (1993) Postoperative patient-controlled analgesia: meta-analyses of initial randomised controlled trials. J Clin Anesth 5: 182–183

    CAS  PubMed  Google Scholar 

  87. Peters JWB, Bandell Hoekstra H, Huijer AS et al (1999) Patient controlled analgesia in children and adolescents. A randomised controlled trial. Paediatr Anaesth 9: 235–241

    CAS  PubMed  Google Scholar 

  88. Walder B, Schafer M, Henzi I, Tramer MR (2001) Efficacy and safety of patient-controlled-opioid analgesia for acute postoperative pain. A qualitative systematic review. Acta Anaestesiol Scand 45: 795–804

    CAS  Google Scholar 

  89. Skues MA, Watson DM, O’Meara M (1993) Patient-controlled-analgesia in children. A comparison of two infusion techniques. Paediatr Anaesth 3: 223–228

    Google Scholar 

  90. Doyle E, Robinson D, Morton NS (1993) Comparison of patient-controlled-children. Br J Anaesth 71: 670–676

    CAS  PubMed  Google Scholar 

  91. Gunter JB (2002) Benefit and risks of local anesthetics in infants and children. Paediatr Drugs 4: 649–672

    PubMed  Google Scholar 

  92. Gajraj NM, Pennant JH, Watcha MF (1994) Eutecticanalgesia with or without a background infusion after lower abdominal surgery in mixture of local anesthetics (EMLA) cream. Anesth Analg 78: 574–583

    CAS  PubMed  Google Scholar 

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  1. Paediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy

    A. Chiaretti & A. Langer

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  1. A. Chiaretti
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Editors and Affiliations

  1. Cambridge

    J. D. Pickard (Editor-in-Chief) (Editor-in-Chief)

  2. Ankara

    N. Akalan

  3. Roma

    C. Di Rocco

  4. Ljubljana

    V.V. Dolenc

  5. Erlangen

    R. Fahlbusch

  6. Lisbon

    J. Lobo Antunes

  7. Lyon

    M. Sindou

  8. Lausanne

    N. de Tribolet

  9. Utrecht

    C. A. F. Tulleken

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Chiaretti, A., Langer, A. (2005). Prevention and Treatment of Postoperative Pain with Particular Reference to Children. In: Pickard, J.D., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 30. Springer, Vienna. https://doi.org/10.1007/3-211-27208-9_6

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  • DOI: https://doi.org/10.1007/3-211-27208-9_6

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