Advertisement

Pediatric Surgery International

, Volume 26, Issue 9, pp 879–889 | Cite as

Implementation of a standardized pain management in a pediatric surgery unit

  • B. MessererEmail author
  • A. Gutmann
  • A. Weinberg
  • A. Sandner-Kiesling
Review Article

Abstract

Postoperative pain is still a major complication causing discomfort and significant suffering, especially for children. Therefore, every effort should be made to prevent pain and treat it effectively once it arises. Under-treatment of pediatric pain is often due to a lack of both knowledge about age-specific aspects of physiology and pharmacology and routine pain assessment. Factors for long term success require regularly assessing pain, as routinely as the other vital signs together with documentation of side effects. The fear of side effects mostly prevents the adequate usage of analgesics. Essential is selecting and establishing a simple concept for clinical routine involving a combination of non-pharmacological treatment strategies, non-opioid drugs, opioids and regional anesthesia.

Keywords

Pain Pain, postoperative Analgesia Pain, assessment Pain, management Pain, children Faces pain scale NSAIDs Acetaminophen Dipyrone Piritramide Patient-controlled analgesia, children Regional analgesia, children 

References

  1. 1.
    Lönnqvist PA, Morton NS (2005) Postoperative analgesia in infants and children. Br J Anaesth 95:59–68PubMedCrossRefGoogle Scholar
  2. 2.
    Petrack EM et al (1997) Pain management in the Emergency Department: patterns of analgesic utilization. Pediatrics 99:711–714PubMedCrossRefGoogle Scholar
  3. 3.
    Bauchner H et al (1992) Use of analgesic agent for invasive medical procedures in pediatric and neonatal intensive care units. J Pediatr 121:647–649PubMedCrossRefGoogle Scholar
  4. 4.
    Schoeffel D, Crasser HR, Bach M et al (2008) Risk assessment in pain therapy. Schmerz 22:594–603PubMedCrossRefGoogle Scholar
  5. 5.
    Walker SM (2008) Pain in children: recent advances and ongoing challenges. Br J Anaesth 101(1):101–110PubMedCrossRefGoogle Scholar
  6. 6.
    Fletcher D, Fermanian C, Marday A et al (2008) A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 137:441–451PubMedCrossRefGoogle Scholar
  7. 7.
    Saur P, Junker U, Gaus P et al (2008) Implementation of a standardized perioperative pain management concept in three hospitals of a consortium. Schmerz 33:34–42CrossRefGoogle Scholar
  8. 8.
    Fanelli G, Berti M, Baciarello M (2008) Updating postoperative pain management: from multimodal to context-sensitive treatment. Minerva Anestesiol 74:489–500PubMedGoogle Scholar
  9. 9.
    Rawal N, Berggren L (1994) Organization of acute pain service: a low cost model. Pain 57:117–123PubMedCrossRefGoogle Scholar
  10. 10.
    Franck LS, Greenberg CS, Stevens B (2000) Pain assessment in infants and children. Pediatr Clin North Am 47:487–512PubMedCrossRefGoogle Scholar
  11. 11.
    Treadwell MJ, Franck LS, Vichinsky E (2002) Using quality improvement strategies to enhance pediatric pain assessment. Int J Qual Health Care 14:39–47PubMedCrossRefGoogle Scholar
  12. 12.
    Dalton JA, Blau W, Lindley C et al (1999) Changing acute pain management to improve patient outcomes: an educational approach. J Pain Symptom Manage 17:277–287PubMedCrossRefGoogle Scholar
  13. 13.
    Eder SC, Todd K, Sloan EP (2001) How well do physicians document pain in the emergency department? Acad Emerg Med 8:427Google Scholar
  14. 14.
    Harmer M, Davies KA (1998) The effect of education, assessment and a standardised prescription on postoperative pain management. The value of clinical audit in the establishment of acute pain services. Anaesthesia 53:424–430PubMedCrossRefGoogle Scholar
  15. 15.
    Straw P, Bruster S, Richards N et al (2000) Sit up, take notice. Health Serv J 5704:24–26Google Scholar
  16. 16.
    Ghai B, Makkar JK, Wig AJ (2008) Postoperative pain assessment in preverbal children with cognitive impairement. Paediatr Anaesth 18:462–477PubMedCrossRefGoogle Scholar
  17. 17.
    Hicks CL et al (2001) The faces pain scale-revised: toward a common metric in pediatric pain measurement. Pain 93(2):173–183PubMedCrossRefGoogle Scholar
  18. 18.
    Büttner W, Finke W, Hilleke M et al (1998) Development of an observational scale for the assessment of postoperative pain in infants. Anasthesiol Intensivmed Notfallmed Schmerzther 3:353–361Google Scholar
  19. 19.
    Breau LM, Finly GA, McGrath PJ et al (2002) Validation of the non-communicating children’s pain checklist-postoperative version. Anesthesiology 96:528–535PubMedCrossRefGoogle Scholar
  20. 20.
    Breau LM, McGrath PJ, Campfield CS et al (2002) Psychometric properties of the non-communicating children’s pain checklist-revised. Pain 99:349–357PubMedCrossRefGoogle Scholar
  21. 21.
    Breau LM, Campfield CS, McGrath PJ (2001) Measuring pain accurately in children with cognitive impairments: refinement of a caregiver scale. J Pediatr 138:721–727PubMedCrossRefGoogle Scholar
  22. 22.
    McGrath PA (1987) An assessment of children’s pain: a review of behavioural, physiological and direct scaling techniques. Pain 31:147–176PubMedCrossRefGoogle Scholar
  23. 23.
    Ware LJ, Epps CD, Herr K (2006) Evaluation of the revised faces pain scale, verbal descriptor scale, numeric rating scale and iowa pain thermometer in older minority adults. Pain manag Nurs 7(3):117–125PubMedCrossRefGoogle Scholar
  24. 24.
    Simons J, Roberson E (2002) Poor communication and knowledge deficits: obstacles to effective management of children’s postoperative pain. J Adv Nurs 40:78–86PubMedCrossRefGoogle Scholar
  25. 25.
    Falanga IJ, Lafrenaye S, Mayer SK et al (2006) Management of acute pain in children: safety and efficacy of a nurse-controlled algorithm for pain relief. Acute pain 8:45–54CrossRefGoogle Scholar
  26. 26.
    Breivik H, Borchgrevink PC, Allen SM (2008) Assessment of pain. Br J Anaesth 101(1):17–24PubMedCrossRefGoogle Scholar
  27. 27.
    Finly GA, Franck L, Grunau R et al (2005) Why children’s pain matters? Pain: Clinical Update XII:1–6Google Scholar
  28. 28.
    Salantera S, Lauri S, Salmi T et al (1999) Nurses’ knowledge about pharmacological and non-pharmacological pain management in children. J Pain Symptom Manage 18:289–299PubMedCrossRefGoogle Scholar
  29. 29.
    Kohler H, Schulz S, Wiebalck A (2001) Pain management in children: assessment and documentation in burn units. Eur J Pediatr Surg 11:40–43PubMedCrossRefGoogle Scholar
  30. 30.
    Simons J, Moseley L (2009) Influences on nurses’ scoring of children’s postoperative pain. J Child Health Care 13(2):101–115PubMedCrossRefGoogle Scholar
  31. 31.
    Tait AR, Voepel-Lewis T, Synder RM et al (2008) Parent’s understanding of information regarding their child’s postoperative pain management. Clin J Pain 24(7):572–577PubMedCrossRefGoogle Scholar
  32. 32.
    Fortier MA, Chorney JM, Roney RY et al (2009) Children’s desire for perioperative information. Anesth Analg 109(4):1085–1090PubMedCrossRefGoogle Scholar
  33. 33.
    Alastair JJ, Berde CB, Sethna NF (2002) Analgesics for the treatment of pain in children. N Engl J Med 347(14):1094–1103CrossRefGoogle Scholar
  34. 34.
    Cote CJ, Kauffman RE, Troendle GJ et al (1996) Is the “therapeutic orphan” about to be adopted? Pediatrics 98:118–123PubMedGoogle Scholar
  35. 35.
    European Commission Enterprise Directorate-General (2002) Better Medicines for children: proposed regulatory actions on pediatric medicinal products. Consultation document. Int J Pharm Med 16:25–29CrossRefGoogle Scholar
  36. 36.
    Schug SA, MacInyre P, Power I et al (2005) The scientific evidence in acute pain management. Acute Pain 7:161–165CrossRefGoogle Scholar
  37. 37.
    Morton NS, O’Brien K (1999) Analgesic efficacy of paracetamol and diclofenac in children receiving PCA morphine. Br J Anaesth 82:715–717PubMedGoogle Scholar
  38. 38.
    Elia N, Lysakowski C, Tramèr MR (2005) Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Anesthesiology 103:1296–1304PubMedCrossRefGoogle Scholar
  39. 39.
    Olkkola KT, Maunuksela EL (1991) The pharmacokinetics of postoperative intravenous keterolac tromethamine in children. Br J Clin Pharmacol 31:182–184PubMedGoogle Scholar
  40. 40.
    Marret E, Kurdi O, Zufferey P et al (2005) Effects of nonsteroidal anti-inflammatory drugs on patient-controlled analgesia morphin side effect: meta-analysis of randomized controlled trials. Anaesthiology 102(6):1249–1260CrossRefGoogle Scholar
  41. 41.
    McQuay HJ, Poon KH, Derry S et al (2008) Acute pain: combination treatments and how we measure their efficacy. Br J Anaesth 101(1):69–76PubMedCrossRefGoogle Scholar
  42. 42.
    Kokki H (2003) Nonsteroidal anti-inflammatory drug for postoperative pain: a focus on children. Paediatr Drugs 5(2):103–123PubMedGoogle Scholar
  43. 43.
    Simon J, Moseley L (2008) Post-operative pain: the impact of prescribing patterns on nurses’ administration of analgesia. Paediatr Nurs 20(8):14–19Google Scholar
  44. 44.
    Rakow H, Finke W, Mutze K et al (2007) Handlungsempfehlungen zur postoperativen Schmerztherapie bei Kindern vom wissenschaftlichen Arbeitskreis Kinderanästhesie der DGAI. Anästhesiologie und Intensivmed 48:S99–S103Google Scholar
  45. 45.
    Schug SA, Manopas A (2007) Update on the role of non-opioids for postoperative pain treatment. Best Pract Res Clin Anaesthesiol 21(1):15–30PubMedCrossRefGoogle Scholar
  46. 46.
    Kokki H, Kumpulainen E, Laisalmi M et al (2008) Diclofenac readily penetrates the cerebrospinal fluid in children. Br J Pharmacol 65(6):879–884CrossRefGoogle Scholar
  47. 47.
    Beck A, Krischak G, Sorg T et al (2003) Influence of diclofenac (group of nonsteroidal anti-inflammatory drugs) on fracture healing. Arch Orthop Trauma Surg 123:327–332PubMedCrossRefGoogle Scholar
  48. 48.
    Boursinos LA, Karachalios T, Poultsides L et al (2009) Do steroids, conventional non-steroidal anti-inflammatory drugs and selective COX-2 inhibitors adversely affect fracture healing? J Musculoskelet Neuronal Interact 9(1):44–52PubMedGoogle Scholar
  49. 49.
    Vestergaard P (2008) Pain-relief medication and risk of fractures. Curr Drug Saf 3(3):199–203PubMedCrossRefGoogle Scholar
  50. 50.
    White PF, Khelet H, Liu S (2009) Perioperative analgesia: what do we still know? Anesth Analg 108(5):1364–1367PubMedCrossRefGoogle Scholar
  51. 51.
    Izhar T (1999) Novalgin in pain and fever. J Pak Med Assoc 49(9):226–227PubMedGoogle Scholar
  52. 52.
    May S, Lis Y (2002) The incidence of metamizole sodium-induced agranulocytosis in Poland. J Int Med Res 30(5):488–495Google Scholar
  53. 53.
    Andrès E, Maloisel F, Zimmer J (2010) The role of haematopoietic growth factors granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor in the management of drug-induced agranulocytosis. Br J Haematol (in press)Google Scholar
  54. 54.
    Jage J, Laufenberg-Feldmann R, Heid F (2008) Drugs for postoperative analgesia: routine and new aspects. Part 1: Non-opioids. Anaesthesist 57:382–390PubMedCrossRefGoogle Scholar
  55. 55.
    Edwards JE, McQuay HJ (2002) Dipyrone and agranulocytosis: what is the risk? Lancet 360:1438PubMedCrossRefGoogle Scholar
  56. 56.
    Spacek A, Goraj E, Neiger FX et al (2003) Superior postoperative analgesic efficacy of a continuous infusion of tramadol and dipyrone (metamizol) versus tramadol alone. Acute Pain 5:3–9CrossRefGoogle Scholar
  57. 57.
    Roberts DW, Bucci TJ, Benson W et al (1991) Immunohistochemical localization and quantification of the 3-(Cystein-S-yl)-acetaminophen protein adduct in acetaminophen hepatotoxicty. Am J Pathol 138:359–371PubMedGoogle Scholar
  58. 58.
    Zimmermann HJ, Maddrey WC (1995) Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instance of therapeutic misadventure. Hepatology 22:767–773CrossRefGoogle Scholar
  59. 59.
    Beasley R, Clayton T, Crane J (2008) Association between paracetamol use in infancy and childhood and risk of asthma, rhinoconjunctivits, and eczema in children aged 6–7 years: analysis from Phase Three of the ISAAC programme. Lancet 372:1039–1048PubMedCrossRefGoogle Scholar
  60. 60.
    Allmers H, Skudlik C, John SM (2009) Acetaminophen use: a risk for asthma? Curr Allergy Asthma Rep 9(2):164–167PubMedCrossRefGoogle Scholar
  61. 61.
    Arana A, Morton NS, Hansen TG (2001) Treatment with paracetamol in infants. Acta Anaesthesiol Scand 45:20–29PubMedCrossRefGoogle Scholar
  62. 62.
    Anderson BJ, Allegaert K (2009) Intravenous neonatal paracetamol dosing: the magic of 10 days. Paediatr Anaesth 19:289–295PubMedCrossRefGoogle Scholar
  63. 63.
    Kehlet H, Dahl JB (1993) The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg 77(5):1048–1056PubMedCrossRefGoogle Scholar
  64. 64.
    Hudcova J, McNicol E, Quah C et al. (2006) Patient controlled opioid analgesiy versus conventional opiod analgesia for postoperative pain. Cochrane Database Syst Rev 18(4):CD 003348Google Scholar
  65. 65.
    Klein-Kremer A, Goldman RD (2007) Opioid administration for acute abdominal pain in the pediatric emergency department. J Opioid Manag 3(1):11–14PubMedGoogle Scholar
  66. 66.
    Sharwood LN, Babl FE (2009) The efficacy and effect of opioid analgesia in undifferential abdominal pain in children: a review of four studies. Paediatr Anaesth 19(5):445–451PubMedCrossRefGoogle Scholar
  67. 67.
    Amoli HA, Golozar A, Keshavarzi S et al (2008) Morphine analgesia in patients with acute appendicits: a randomised double-blind clinical trial. Emerg Med J 25(9):586–589PubMedCrossRefGoogle Scholar
  68. 68.
    Helfand M, Freeman M (2009) Assessment and management of acute pain in adult medical inpatients: a systemic review. Pain Med 10(7):1183–1199PubMedCrossRefGoogle Scholar
  69. 69.
    Pace S, Burke T et al (1996) Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med 3:1086–1092PubMedCrossRefGoogle Scholar
  70. 70.
    Manerola C, Astudillo P, Losada H et al (2007) Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 18(3):CD005660Google Scholar
  71. 71.
    Jellinek H, Haumer H, Grubhofer G (1990) Tramadol in postopeative pain therapy: patient controlled analgesia versus continuous infusion. Anaesthesist 39:513–520PubMedGoogle Scholar
  72. 72.
    Stamer UM, Höthker F, Lehnen K et al (2003) Postoperative analgesia with tramadol and metamizol: continual infusion versus patient controlled analgesia. Anaesthesist 52:33–41PubMedCrossRefGoogle Scholar
  73. 73.
    Aubrun F, Monsel S, Langeron O et al (2001) Postoperative titration of intravenous morphine. Eur J Anaesthesiol 18:159–165PubMedGoogle Scholar
  74. 74.
    Aubrun F, Salvi N, Coriat P et al (2005) Sex- and age-related differences in morphine requirements for postoperative pain relief. Anesthesiology 103:156–160PubMedCrossRefGoogle Scholar
  75. 75.
    Yno Y, Beal SL, Sheiner LB (2001) Evaluating pharmacolokinetic pharmacodynamic/models using the posterior predictive check. J Pharmacokinet Pharmacodyn 28:171–192CrossRefGoogle Scholar
  76. 76.
    Kart T, Christrup LL, Rasmussen M (1997) Recommended use of morphine in neonates, infants and children based on a literature review. 1. Pharmacokinetics. Paediatr Anaesth 7:5–11PubMedCrossRefGoogle Scholar
  77. 77.
    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 7:93–101PubMedGoogle Scholar
  78. 78.
    Giesa M, Decking J, Roth KE et al (2007) Acute pain management after orthopaedic surgery. Schmerz 21:73–84PubMedCrossRefGoogle Scholar
  79. 79.
    Duarte LT, Fernandes Mdo C et al (2009) The incidence of postoperative respiratory depression in patients undergoing intraveous or epidural analgesia with opioids. Rev Bras Anesthesiol 59(4):409–420Google Scholar
  80. 80.
    Hudcova J, McNicol E, Quah C et al (2005) Patient controlles intravenous opioid analgesia versus conventional opioid analgesis for postoperative pain control:a quantitative systematic review. Acute Pain 7:115–132CrossRefGoogle Scholar
  81. 81.
    Birmingham PK, Suresh S, Rae BR et al (2003) Patient-controlled epidural analgesia in children: can they do it? Anesth Analg 96:686–691PubMedGoogle Scholar
  82. 82.
    Grass JA (2005) Patient controlled analgesia. Anesth Analg 101:S44–S61PubMedCrossRefGoogle Scholar
  83. 83.
    Elia N, Lysakowski C, Tramèr MR (2005) Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trial. Anesthesiology 103(6):1296–1304PubMedCrossRefGoogle Scholar
  84. 84.
    Reichl S, Pogatzki-Zahn E (2009) Concepts for perioperative pain therapy. A critical stocktaking. Anaesthesist 58:914–930PubMedCrossRefGoogle Scholar
  85. 85.
    Becke K, Kranke P, Weiss M (2007) Handlungsempfehlung zur Risikoeinschätzung, Prophylaxe und Therapie von Postoperativem Erbrechen im Kindesalter. Anästh Intensivmed 49:S95–S98Google Scholar
  86. 86.
    Brodner G et al (2000) Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients. Eur J Anaesthesiol 17:566–575PubMedGoogle Scholar
  87. 87.
    Richman MJ et al (2006) Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 102:248–257PubMedCrossRefGoogle Scholar
  88. 88.
    Gille J, Gille M, Gahr R et al (2006) Acute pain management in proximal femoral fractures. Femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model. Anaesthesist 55:414–422PubMedCrossRefGoogle Scholar
  89. 89.
    Werawatganon T, Charuluxanun S (2005) Patient controllrd intravenous opioid analgesia versus continuous epidural analgesia for pain after intra-abdominal surgery. Cochrane Database Syst Rev 1:CD004088Google Scholar
  90. 90.
    Nishimori M, Ballantyne JC (2006) Low JH. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 3:CD005059Google Scholar
  91. 91.
    Steinbrook RA (1998) Epidural analgesia nad gastrointestinal mortality. Anesth Analg 86:837–844PubMedCrossRefGoogle Scholar
  92. 92.
    Giaufre E, Dalens B, Gombart A (1996) Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French- Language society of Pediatric Anesthesiologists. Anesth Analg 83:904–912PubMedCrossRefGoogle Scholar
  93. 93.
    Dadure C, Bringuier S, Raux O et al (2009) Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters. Can J Anaesth 56:843–850PubMedCrossRefGoogle Scholar
  94. 94.
    Höhne C (2007) Regional anesthesia in preterm, newborns and small infants. Anasthesiol Intensivmed Notfallmed Schmerzther 9:616–621Google Scholar
  95. 95.
    Ivani G, Mossetti V (2009) Pediatric regional anesthesia. Minerva Anestesiol 75:577–583PubMedGoogle Scholar
  96. 96.
    Hillmann R, Kretz FJ (2008) Risks and danger in pediatric regional anaesthesia. Anaesthesiat 57:165–174CrossRefGoogle Scholar
  97. 97.
    Howard RF (2010) Audits of postoperative analgesia: what have we learned and what should we do now? Paediatric Anaesth 20:117–118CrossRefGoogle Scholar
  98. 98.
    Pöppinger DM, Zahn PK, van Aken HK et al (2008) Effectiveness and safty of postoperative pain management: a survey of 18925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 101(6):832–840CrossRefGoogle Scholar
  99. 99.
    Kehlert H, Holte K (2001) Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87:62–72CrossRefGoogle Scholar
  100. 100.
    Kehlert H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641CrossRefGoogle Scholar
  101. 101.
    Moiniche S, Mikkelsen S, Wetterslev J et al (1998) A qualitative systemic review of incisional local anesthesia for postoperative pain relif after abdominal operations. Br J Anaesth 81:377–383PubMedGoogle Scholar
  102. 102.
    Cnar SO, Kum U, Cevizci N et al (2009) Effects of levobupivacaine infiltration on postoperative analgesia and stress response in children following inguinal repair. Eur J Anaesthesiol 26(5):430–434PubMedCrossRefGoogle Scholar
  103. 103.
    Horn EP, Schroeder F, Wilhelm S et al (1999) Wound infiltration and drain lavage with ropivacaine after major shoulder surgery. Anesth Analg 89:1461–1466PubMedCrossRefGoogle Scholar
  104. 104.
    Capdevila X, Pirat P, Bringuier S et al (2005) Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the postoperative analysis of the quality of postoperative analgesia and complications in 1416 patients. Anesthesiology 103:1035–1045PubMedCrossRefGoogle Scholar
  105. 105.
    Berde CB (1992) Convulsions associated with pediatric regional anesthesia. Anesth Analg 75:164–166PubMedCrossRefGoogle Scholar
  106. 106.
    Henderson K, Sethna NF, Berde CB (1993) Continuous caudal anesthesia for inguinal hernia repair in former preterm infants. J Clin Anesth 5:129–133PubMedCrossRefGoogle Scholar
  107. 107.
    Liu SS (2004) Anesthesia and analgesia for colon surgery. Reg Anesth Pain Med 29:52–57PubMedGoogle Scholar
  108. 108.
    Bringuier S, Dadure C, Raux O et al (2009) The perioperative validity of the visual analog anxiety scale in children: a discriminate and useful instrument in routine clinical practice to optimize postoperative pain management. Anesth Analg 1009(3):737–744CrossRefGoogle Scholar
  109. 109.
    Lefrk L, Burch K, Caravantes R et al (2006) Sucrose analgesia identifying potentially better practices. Pediatrics 118(Suppl.2):S197–S202CrossRefGoogle Scholar
  110. 110.
    Lago P, Garetti E, Merazzi D (2009) Guidelines for procedural pain in the newborn. Acta Paediatr 98:932–939PubMedCrossRefGoogle Scholar
  111. 111.
    Bellieni CV, Iantorno L, Perrone S et al (2009) Event routine painful procedures can be harmful for newborn. Pain 147:128–131PubMedCrossRefGoogle Scholar
  112. 112.
    Skogsdal Y, Eriksson M, Schollin J (1997) Analgesia in newborn given oral glucose. Acta Paediatr 86:217–220PubMedCrossRefGoogle Scholar
  113. 113.
    Carbajal RR, Chauvet X, Couderc S (1999) Randomised trial of analgesic effects of sucrose, glucose and pacifier in term neonates. BMJ 319:1393–1397PubMedGoogle Scholar
  114. 114.
    Willis D, Chabot J, Raddle I et al (1977) Unsuspected hyperosmolarity of oral solutions contributing to necrotizing enterocolitis in very-low-birth-weight infants. Pediatrics 60:535–538PubMedGoogle Scholar
  115. 115.
    Howard R, Carter B, Curry J (2008) Quick reference summery of recommendations and good practice points. Paediatr Anaesth 18(Suppl 1):4–13PubMedGoogle Scholar
  116. 116.
    Schöps P, Seeger D (2009) Physiomedical therapy of acute and chronic pain. Schmerz 23:191–212PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • B. Messerer
    • 1
    Email author
  • A. Gutmann
    • 1
  • A. Weinberg
    • 2
  • A. Sandner-Kiesling
    • 1
  1. 1.Department of Anesthesiology and Intensive Care MedicineMedical University of GrazGrazAustria
  2. 2.Department of Pediatric and Adolescent SurgeryMedical University of GrazGrazAustria

Personalised recommendations