Pharmacological prevention and management

  • Bernadette Carter

Abstract

Effective pain management stems from the use of a multi-method approach and it must be remembered that for the child their pain may result not only from the original disease/illness but also from the many invasive and traumatic procedures that they encounter. Pain management must attempt to ensure that pain from all sources is eliminated or reduced. Effective pain management should involve a multi-method approach. One child, for example, may find that their pain is relieved by the use of a combination of appropriate doses of opioid analgesia, relaxation techniques and massage. Alternatively another child may find benefit and derive pain control from the use of oral analgesia and distraction techniques. The situation where the nurse relies solely on the child’s drug sheet for pain management is long gone and the nurse caring for the child should encourage the use of the techniques that the child and family know and trust as well as offering new approaches. Obviously nurses must be skilled and knowledgeable in all forms of pain management and should never attempt to utilize a strategy that lies outside their experience and competence. However, whilst the place of distraction, imagery, touch, massage, hypnosis and other forms of supportive or complementary care cannot, and should not, be denied, the appropriate use of pharmacological methods of pain management is of crucial importance. An essential part of the pharmacological management of the child’s pain lies in delivery of skilful nursing care. Nurses involved in the administration of drugs for the relief of pain should have a sound underpinning knowledge not only of how the drugs work, what interactions should be considered, possible side-effects and contraindications but also the effects of the maturation on the disposition of the drug given.

Keywords

Aspirin Morphine Histamine Prostaglandin Fentanyl 

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References

  1. Alder, S. (1990) Taking children at their word: pain control in paediatrics. Professional Nurse, May: 398–402.Google Scholar
  2. American Pain Society (1989) Principles of analgesic use in the treatment of acute pain or chronic cancer pain. American Pain Society, Washington.Google Scholar
  3. Beasley, S.W. and Tibbalis, J. (1987) Efficacy and safety of continuous morphine infusion for postoperative analgesic in the paediatric surgical ward. Australian and New Zealand Journal of Surgery, 57: 233–237.PubMedCrossRefGoogle Scholar
  4. Bender, L.H., Weaver, K. and Edwards, W. (1990) Postoperative patient-controlled analgesia in children. Pediatric Nursing, 16 (6): 549–554.PubMedGoogle Scholar
  5. Berde, C. (1989) Regional analgesia in the management of chronic pain in children. Journal of Pain and Symptom Management, 4 (4): 232–237.PubMedCrossRefGoogle Scholar
  6. Berde, C., Albin, A. and Glazer, J. (1990a) Report of the subcommittee of disease related pain in childhood cancer. Pediatrics, 86 (65): 818–825.PubMedGoogle Scholar
  7. Berde, C.B., Sethna, N.F., Yemen, T.A. et al. (1990b) Continuous epidural bupivicaine-fentanyl infusion in children following ureteral reimplantation (Abstract). Anesthesia and Analgesia, 73: A1128.Google Scholar
  8. Berde, C.B., Lehn, B.M., Yee, J.D., Sethna, N.F. and Russo, D. (1991) Patient-controlled analgesia in children and adolescents: a randomized, prospective comparison with intramuscular morphine for postoperative analgesia. Journal of Pediatrics, 118: 460–466.PubMedCrossRefGoogle Scholar
  9. Beyer, J. and Arandine, C. (1986) Content validity of an instrument to measure young children’s perception of the intensity of their pain. Journal of Pediatric Nursing, 1 (6): 386–395.PubMedGoogle Scholar
  10. Beyer, J.E. and Byers, M.L. (1985) Knowledge of pediatric pain: the state of the art. Children’s Health Care, 13 (4): 150–159.CrossRefGoogle Scholar
  11. Burokas, L. (1985) Factors affecting nurses’ decisions to medicate patients after surgery. Heart and Lung, 14 (4): 373–379.PubMedGoogle Scholar
  12. Dalens, B. (1993) Peripheral nerve blockade in the management of postoperative pain in children. In: Schechter, N.L., Berde, C.B. and Yaster, M. (eds), Pain in Infants, Children, and Adolescents. Williams and Wilkins, Baltimore, pp. 261–280.Google Scholar
  13. Davis, K.L. (1990) Postoperative pain in toddlers: nurses’ assessment and intervention. In: Tyler, D.C.and Krane, E.J. (eds), Advances in Pain Research Therapy, Vol. 15. Raven Press, New York, pp. 53–61.Google Scholar
  14. Davitz, L. and Davitz, J. (1975) How nurses view patient suffering. Registered Nurse, 38: 69–74.Google Scholar
  15. Desparmet, J.F. (1993) Central blocks in children and adolescents. In: Schechter, N.L., Berde, C.B. and Yaster, M. (eds), Pain in Infants, Children, and Adolescents. Williams and Wilkins, Baltimore, pp. 245–260.Google Scholar
  16. Desparmet, J., Desmazs, N., Mazoit, X. and Ecoffey, C. (1990) Evolution of regional anesthesia in a pediatric surgical practice. In: Tyler, D.C. and Krane, E.J. (eds), Advances in Pain Research Therapy, Vol. 15, Raven Press, New York, pp. 201–207.Google Scholar
  17. Desparmet, J., Meiselman, C., Barre, J. and Saint-Maurice, C. (1987) Continuous epidural infusion of bupivicaine for post-operative pain relief in children. Anesthesiology, 67: 108–110.PubMedCrossRefGoogle Scholar
  18. Dilworth, N.M. and MacKellar, A. (1987) Pain relief for the pediatric surgical patient. Journal of Pediatric Surgery, 22: 264–266.PubMedCrossRefGoogle Scholar
  19. Dodd, E., Wang, J.M. and Rauck, R.L. (1988) Patient controlled analgesia for postsurgical pediatric patients ages 6–16 years. Anesthesiology, 69: A372.CrossRefGoogle Scholar
  20. Ecoffey, C. (1990) Regional anesthesia techniques in children. In: Tyler, D.C. and Krane, E.J. (eds), Advances in Pain Research Therapy, Vol. 15. Raven Press, New York, pp. 157–165.Google Scholar
  21. Eland, J.M. (1990) Pain in children. Nursing Clinics of North America, 25 (4): 871–874.PubMedGoogle Scholar
  22. Eland, J.M. and Anderson, J.E. (1977) The experience of pain in children. In: Jacox, A.K. (ed.), Pain: A Sourcebook for Nurses and Other Health Professionals. Little, Brown and Co., Boston, pp. 453–471.Google Scholar
  23. Franck, L.S. (1987) A national survey of the assessment and treatment of pain and agitation in the neonatal intensive care unit. Journal of Obstetrics, Gynecology and Neonatal Nursing, 16 (6): 387–393.CrossRefGoogle Scholar
  24. Gadish, H.S., Gonzalez, J.L. and Hayes, J.S. (1988) Factors affecting nurses’ decisions to administer pediatric pain medication postoperatively. Journal of Pediatric Nursing: Nursing Care of Children and Families, 3 (6): 383–390.Google Scholar
  25. Gaukroger, P.B. (1993a) Novel techniques of analgesic delivery. In: Schechter, N.L., Berde, C.B. and Yaster, M. (eds), Pain in Infants, Children, and Adolescents. Williams and Wilkins, Baltimore, pp. 195–201.Google Scholar
  26. Gaukroger, P.B. (1993b) Patient-controlled analgesia in children. In: Schechter, N.L., Berde, C.B. and Yaster, M. (eds), Pain in Infants, Children, and Adolescents. Williams and Wilkins, Baltimore, pp. 203–211.Google Scholar
  27. Gillespie, J. and Morton, N. (1992) Patient-controlled analgesia for children: a review. Pediatric Anaesthesia, 2: 51–59.CrossRefGoogle Scholar
  28. Goldman, A. and Lloyd-Thomas, A.R. (1991) Pain management in children. In: Wells, J.C.D. and Woolf, C.J. (eds), Pain Mechanisms and Management, Churchill Livingstone, Edinburgh, pp. 676–689.Google Scholar
  29. Grahame-Smith, D.G. and Aronson, J.K. (1992) Oxford Textbook of Clinical Pharmacology and Drug Therapy. Oxford University Press, Oxford.Google Scholar
  30. Jaffe, P. (1993) Relief only when desperate. Nursing Standard Supplement, 7 (25): 6.Google Scholar
  31. Koren, G., Butt, W., Chinyanga, H., Soldin, S., Tan, Y.-K., and Pape, K. (1985) Postoperative morphine infusion in newborn infants: assessment of disposition characteristics and safety. Journal of Pediatrics, 107 (6): 963–967.PubMedCrossRefGoogle Scholar
  32. Lavies, N.G. and Wandless, J.G. (1989) Subcutaneous morphine in children: taking the sting out of postoperative analgesia. Anaesthesia, 44: 1000–1001.PubMedCrossRefGoogle Scholar
  33. Levi, P. and Osborne, J. (1986) Patient controlled analgesia: traditional versus mechanical. Journal of Nursing Administration, 16 (9): 18–19.PubMedGoogle Scholar
  34. Llewellyn, N. (1993) A.P.S. A multidisciplinary team. Nursing Standard Supplement, 7 (25): 7.Google Scholar
  35. Lloyd-Thomas, A.R. (1990) Pain management in paediatric patients. British Journal of Anaesthesia, 64: 85–104.PubMedCrossRefGoogle Scholar
  36. Mahé, V. and Ecoffey, C. (1988) Spinal anaesthesia with isobaric bupivicaine in infants. Anesthesiology, 68: 601–603.PubMedCrossRefGoogle Scholar
  37. Mather, L. E. and Mackie, J. (1983) The incidence of postoperative pain in children. Pain, 15: 271–282.PubMedCrossRefGoogle Scholar
  38. Maunuksela, E.-L. (1993) Nonsteroidal anti-inflammatory drugs in pediatric pain management. In: Schechter,N.L., Berde, C.B. and Yaster, M. (eds), Pain in Infants, Children, and Adolescents. Williams and Wilkins, Baltimore, pp. 135–143.Google Scholar
  39. McCaffery, M. (1977) Pain relief for the child. Pediatric Nursing, 3 (4): 11–16.PubMedGoogle Scholar
  40. McGrath, P.J. and Unruh, A. (1987) Pain in Children and Adolescents. Elsevier, Amsterdam.Google Scholar
  41. McQuay, H.J. (1992) The relief of pain. In: Grahame-Smith, D.G. and Aronson, J.K. (eds), Oxford Textbook of Clinical Pharmacology and Drug Therapy. Oxford University Press, Oxford, pp. 458–464.Google Scholar
  42. Miser, A.W., Davis, D.M., Hughs, C.S., Mulne, A.F. and Miser, J.S. (1983) Continuous subcutaneous infusion of morphine in children with cancer. American Journal of Diseases in Children, 137: 383–385.Google Scholar
  43. Morton, N. (1993) Balanced analgesia for children. Nursing Standard Supplement, 7 (25): 8–10.Google Scholar
  44. Okkola, K., Maunnksela, E.L., Korpela, R. and Rosenberg, P.H. (1988) Kinetics and dynamics of postoperative intravenous morphine in children. Clinical Pharmacology and Therapeutics, 44: 128–136.CrossRefGoogle Scholar
  45. Page, G.G. (1991) Chronic pain and the child with juvenile rheumatoid arthritis. Journal of Pediatric Health Care, 5 (1): 18–23.PubMedCrossRefGoogle Scholar
  46. Panfilli, R., Brunckhorst, L. and Dundon, R. (1988) Nursing implications of patient-controlled analgesia. Journal of Intravenous Nursing, 11 (2): 75–77.PubMedGoogle Scholar
  47. Price, S. (1991) Student nurses and children’s pain. Nursing Standard, 5 (29): 25–28.PubMedGoogle Scholar
  48. Price, S. (1992) Student nurses’ assessment of children in pain. Journal of Advanced Nursing, 17: 441–447.PubMedCrossRefGoogle Scholar
  49. Rauen, K.H. and Ho, M. (1989) Children’s use of patient controlled analgesia after spine surgery. Pediatric Nursing, 15 (6): 589–593.PubMedGoogle Scholar
  50. Rodgers, B.M., Webb, C.J., Stergois, D. et al. (1988) Patient-controlled analgesia in pediatric surgery. Journal of Pediatric Surgery, 23: 259–262.PubMedCrossRefGoogle Scholar
  51. Roop Moyer, S.M. and Howe, C.J. (1991) Pediatric pain intervention in the PACU. Critical Care Nursing Clinics of North America, 3 (1): 49–57.Google Scholar
  52. Sartori, P.C.E., Gordon, G.J. and Darbyshire, P.J. (1990) Continuous papaveretum infusion for control of pain in painful sickling crisis. Archives of Disease in Childhood, 65: 1151–1153.PubMedCrossRefGoogle Scholar
  53. Schechter, N., Allen, D.A. and Hanson, K. (1986) Status of pediatric pain control: a comparison of hospital analgesic use in children and adults. Pediatrics, 77 (1): 11–15.PubMedGoogle Scholar
  54. Schechter, N., Berrien, F. and Shoshana, M. (1988) PCA for adolescents in sickle cell crisis. American Journal of Nursing, 88 (5): 719–722.PubMedGoogle Scholar
  55. Schechter, N.L., Weisman, S.J., Rosenblum, M., Beck, A., Altman, A., Quinn, J. and Conrad, P.F. (1990) Sedation for pain procedures in children with cancer using the fentanyl lollipop: a preliminary report. In: Tyler, D.C. and Krane, E.J. (eds), Advances in Pain Research Therapy, Vol. 15. Raven Press, New York, pp. 209–214.Google Scholar
  56. Sethna, N.F. and Wilder, R.T. (1993) Regional anesthetic techniques for chronic pain. In: Schechter, N.L., Berde, C.B. and Yaster, M. (eds), Pain in Infants, Children and Adolescents. Williams and Wilkins, Baltimore, pp. 281–293.Google Scholar
  57. Wahstedt, C., Kollberg, G., Solh, H., Greenberg, M. and deVeber, L. (1987) Lignocaine—Prilocaine cream reduces venepuncture pain. Lancet, 106.Google Scholar
  58. Wates, L. (1992) Pharmacologic strategies for managing pain in children. Orthopedic Nursing, 11 (1): 34–40.Google Scholar
  59. Webb, C.J., Stergois, D.A. and Rodgers, B.M. (1989) Patient-controlled analgesia as postoperative pain treatment for children. Journal of Pediatric Nursing, 4 (3): 151–159.Google Scholar
  60. Whaley, L.F. and Wong, D.L. (1991) Nursing Care of Infants and Children. Mosby—Year Book, St Louis.Google Scholar
  61. Williams, J. (1987) Managing paediatric pain. Nursing Times, 83 (36): 36–39.PubMedGoogle Scholar
  62. Williamson, P.S. and Williamson, M.L. (1983) Physiologic stress reduction by local anesthetic during newborn circumcision. Pediatrics, 71 (1): 36–40.PubMedGoogle Scholar
  63. Woolf, C.J. (1989) Recent advances in the pathophysiology of acute pain. British Journal of Anaesthesia, 63: 139–146.PubMedCrossRefGoogle Scholar
  64. Yaster, M. (1987) Analgesia and anesthesia in neonates. Journal of Pediatrics, 111: 394–395.PubMedCrossRefGoogle Scholar
  65. Yaster, M. and Deshpande, J.K. (1988) Management of pediatric pain with opioid analgesics. Journal of Pediatrics, 113 (3): 421–429.PubMedCrossRefGoogle Scholar
  66. Yaster, M. and Maxwell, L.G. (1989) Pediatric regional analgesia. Anesthesiology, 70: 324–338.PubMedCrossRefGoogle Scholar
  67. Yaster, M. and Maxwell, L.G. (1993) Opioid agonists and antagonists. In: Schechter, N.L., Berde, C.B. and Yaster, M. (eds), Pain in Infants, Children and Adolescents. Williams and Wilkins, Baltimore, pp. 145–171.Google Scholar
  68. Yaster, M. (1990) Midazolam—fentanyl intravenous sedation in children: case report of respiratory arrest. Pediatrics, 86 (3): 463–467.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1994

Authors and Affiliations

  • Bernadette Carter
    • 1
  1. 1.Manchester Metropolitan UniversityManchesterUK

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