Skip to main content
SpringerLink
Log in

Perioperative Analgesia and Pain Management in Pediatric Patients

  • Chapter
  • First Online:
Perioperative Pain Control: Tools for Surgeons

  • 620 Accesses

Abstract

This chapter reviews the current evidence regarding perioperative pain management strategies in pediatric patients. Adequate pain control is vital to ensuring patient safety and successful postoperative care, but it can be very challenging to attain. As protocols and practices vary across specialties performing surgeries on children, it is essential for providers to proactively acknowledge, assess, and anticipate pediatric pain in order to apply appropriate management strategies that meet the needs of their patients before, during, and after surgery. While strides have been made in the reduction of opioid use and the optimization of perioperative pharmacotherapy, some effective non-pharmacologic efforts have been much more variable in their scope and implementation. Recognizing the impact of perioperative pain on a patient’s physical, emotional, and psychological well-being is crucial for reducing overall morbidity and improving surgical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ferland CE, Vega E, Ingelmo PM. Acute pain management in children: challenges and recent improvements. Curr Opin Anaesthesiol. 2018;31:327–32.

    Article  PubMed  Google Scholar 

  2. Fortier MA, Kain ZN. Treating perioperative anxiety and pain in children: a tailored and innovative approach. Paediatr Anaesth. 2015;25(1):27–35. https://doi.org/10.1111/pan.12546.

    Article  PubMed  Google Scholar 

  3. Sutters KA, Miaskowski C. Inadequate pain management and associated morbidities in children at home after tonsillectomy. J Pediatr Nurs. 1997;12(3):178–85.

    Article  CAS  PubMed  Google Scholar 

  4. Vagnoli L, Bettini A, Amore E, et al. Relaxation-guided imagery reduces perioperative anxiety and pain in children: a randomized study. Eur J Pediatr. 2019;178:913–21. https://doi.org/10.1007/s00431-019-03376-x.

    Article  PubMed  Google Scholar 

  5. Coté CJ, Wilson S, American Academy of Pediatrics, et al. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019;143(6):pii: e20191000. https://doi.org/10.1542/peds.2019-1000.

    Article  Google Scholar 

  6. Kain ZN, Mayes LC, Caldwell-Andrews AA, et al. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651–8. https://doi.org/10.1542/peds.2005-2920.

    Article  PubMed  Google Scholar 

  7. Redmann AJ, Wang Y, Furstein J, et al. The use of the FLACC pain scale in pediatric patients undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2017;92:115–8. https://doi.org/10.1016/j.ijporl.2016.11.016.

    Article  PubMed  Google Scholar 

  8. Balakas K, Gallaher CS, Tilley C. Optimizing perioperative care for children and adolescents with challenging behaviors. MCN Am J Matern Child Nurs. 2015;40(3):153–9. https://doi.org/10.1097/NMC.0000000000000124.

    Article  PubMed  Google Scholar 

  9. Bruce J, Quinlan J. Chronic post-surgical pain. Rev Pain. 2011;5(3):23–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Taddio A, Goldbach M, Ipp M, et al. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995;345(8945):291–2.

    Article  CAS  PubMed  Google Scholar 

  11. Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med. 1998;152(2):147–9.

    Article  CAS  PubMed  Google Scholar 

  12. Panella JJ. Preoperative care of children: strategies from a child life perspective. AORN J. 2016;104(1):11–22. https://doi.org/10.1016/j.aorn.2016.05.004.

    Article  PubMed  Google Scholar 

  13. DeMaso DR, Snell C. Promoting coping in children facing pediatric surgery. Semin Pediatr Surg. 2013;22:34–138. https://doi.org/10.1053/j.sempedsurg.2013.04.004.

    Article  Google Scholar 

  14. Brewer S, Gleditsch SL, Syblik D, et al. Pediatric anxiety: child life intervention in day surgery. J Pediatr Nurs. 2006;21(1):13–22. https://doi.org/10.1016/j.pedn.2005.06.004.

    Article  PubMed  Google Scholar 

  15. Campbell HT, Yuhan BT, Smith B, et al. Perioperative analgesia for patients undergoing otologic surgery: an evidence-based review. Laryngoscope. 2019;9999:1–10.

    Google Scholar 

  16. Chambers CT, Reid GJ, McGrath PJ, Finley GA. Development and preliminary validation of a postoperative pain measure for parents. Pain. 1996;68(2–3):307–13.

    Article  CAS  PubMed  Google Scholar 

  17. Guidelines WHO. On the pharmacological treatment of persisting pain in children with medical illnesses. Geneva: World Health Organization; 2012.

    Google Scholar 

  18. Walker S. Pain after surgery in children: clinical recommendations. Curr Opin Anaesthesiol. 2015;28(5):570–6. https://doi.org/10.1097/ACO.0000000000000227.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Harbaugh CM, Lee JS, Hu HM, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018;141(1):e20172439. https://doi.org/10.1542/peds.2017-2439.

    Article  PubMed  Google Scholar 

  20. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar BI. Goodenough, The faces pain scale-revised: toward a common metric in pediatric pain measurement. Pain. 2001;93:173–83.

    Article  PubMed  Google Scholar 

  21. Garra G, Singer AJ, Taira BR, Chohan J, Cardoz H, Chisena E, Thode HC. Validation of the Wong-Baker FACES pain rating scale in pediatric emergency department patients. Acad Emerg Med. 2010;17:50–4.

    Article  PubMed  Google Scholar 

  22. Muller RG, Thimmappa V, Sheyn A. Post-operative pain control following pediatric otolaryngology surgery. Madridge J Otorhinolaryngol. 2018;3(1):37–40.

    Article  Google Scholar 

  23. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293–7.

    CAS  PubMed  Google Scholar 

  24. Manworren RC, Stinson J. Pediatric pain measurement, assessment, and evaluation. Semin Pediatr Neurol. 2016;23(3):189–200. https://doi.org/10.1016/j.spen.2016.10.001.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Büttner W, Finke W. Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies. Paediatr Anaesth. 2000;10(3):303–18.

    Article  PubMed  Google Scholar 

  26. Rodríguez MC, Villamor P, Castillo T. Assessment and management of pain in pediatric otolaryngology. Int J Pediatr Otorhinolaryngol. 2016;90:138–49. https://doi.org/10.1016/j.ijporl.2016.09.015.

    Article  PubMed  Google Scholar 

  27. Hannam JA, Anderson BJ, Mahadevan M, Holford NH. Postoperative analgesia using diclofenac and acetaminophen in children. Paediatr Anaesth. 2014;24:953–61.

    Article  PubMed  Google Scholar 

  28. Wong I, St John-Green C, Walker SM. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Paediatr Anaesth. 2013;23(6):475–95.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kelly LE, Rieder M, van den Anker J, Malkin B, Ross C, Neely MN, Carleton B, Hayden MR, Madadi P, Koren G. More codeine fatalities after tonsillectomy in north American children. Pediatrics. 2012;129(5):1343–7.

    Article  Google Scholar 

  30. Quinn BL, Sheldon LK, Cooley ME. Pediatric pain assessment by drawn faces scales: a review. Pain Manag Nurs. 2014;15(4):909–18. https://doi.org/10.1016/j.pmn.2014.03.004. Epub 2014 Jun 25.

    Article  PubMed  Google Scholar 

  31. Helgadottir HL. Pain management in children after surgery. J Pediatr Nurs. 2000;15(5):334–40.

    Article  CAS  PubMed  Google Scholar 

  32. Wilson ME, Helgadottir HL. Patterns of pain and analgesic use in 3- to 7-year-old children after tonsillectomy. Pain Manag Nurs. 2006;7(4):159–66.

    Article  PubMed  Google Scholar 

  33. Finley GA, McGrath PJ, Forward SP, Mcneill G, Fitzgerald P. Parents’ management of children’s pain following ‘minor’ surgery. Pain. 1996;61(1):83–7.

    Article  Google Scholar 

  34. Committee on Hospital Care and Child Life Council. American academy of pediatrics policy statement: child life services. Pediatrics. 2014;133(5):e1471–8. https://doi.org/10.1542/peds.2014-0556.

    Article  Google Scholar 

  35. Birnie KA, Noel M, Chambers CT, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2018;10:CD005179.

    PubMed  Google Scholar 

  36. Wren AA, Ross AC, D’Souza G, et al. Multidisciplinary pain management for pediatric patients with acute and chronic pain: a foundational treatment approach when prescribing opioids. Children. 2019;6(33):1–22.

    Google Scholar 

  37. Delgado-Charro MB, Guy RH. Effective use of transdermal drug delivery in children. Adv Drug Deliv Rev. 2014;73:63–82. https://doi.org/10.1016/j.addr.2013.11.014.

    Article  CAS  PubMed  Google Scholar 

  38. Lexicomp Online. Ondansetron (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  39. Lexicomp Online. Scopolamine (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  40. Lexicomp Online. Midazolam (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  41. Zhu A, Benzon HA, Anderson TA. Evidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populations: a systematic review. Anesth Analg. 2017;125(5):1569–87. https://doi.org/10.1213/ANE.0000000000002434.

    Article  CAS  PubMed  Google Scholar 

  42. Hippard HK, Govindan K, Friedman EM, et al. Postoperative analgesic and behavioral effects of intranasal fentanyl, intravenous morphine, and intramuscular morphine in pediatric patients undergoing bilateral myringotomy and placement of ventilating tubes. Anesth Analg. 2012;115(2):356–63.

    Article  CAS  PubMed  Google Scholar 

  43. Raney EM, van Bosse HJP, Shea KG, Abzug JM, Schwend RM. Current state of the opioid epidemic as it pertains to pediatric orthopaedics from the advocacy Committee of the Pediatric Orthopaedic Society of North America. J Pediatr Orthop. 2018;38(5):E238–44. https://doi.org/10.1097/BPO.0000000000001143.

    Article  PubMed  Google Scholar 

  44. Santana L, Lovejoy JF, Kiebzak G, Day J, Atanda A Jr, Mandel D. Comparison of pain scores and medication usage between three pain control strategies for pediatric anterior cruciate ligament surgery. Cureus. 2019;11(8):e5498. https://doi.org/10.7759/cureus.5498.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric regional anesthesia network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115(6):1353–64. https://doi.org/10.1213/ANE.0b013e31825d9f4b.

    Article  CAS  PubMed  Google Scholar 

  46. Karnik P, Dave N, Shah H, Kulkarni K. Comparison of ultrasound-guided transversus abdominis plane (TAP) block versus local infiltration during paediatric laparoscopic surgeries. Indian J Anaesth. 2019;63(5):356.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Fuchs ME, Beecroft N, McLeod DJ, Dajusta DG, Ching CB. Intraoperative onabotulinumtoxin-a reduces postoperative narcotic and anticholinergic requirements after continent bladder reconstruction. Urology. 2018;118:183–8. https://doi.org/10.1016/j.urology.2018.04.006.

    Article  PubMed  Google Scholar 

  48. Schnabel A, Reichl SU, Poepping DM, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta-analysis of randomized controlled trials. Pediatr Anesth. 2013;23(2):170–9. https://doi.org/10.1111/pan.12030.

    Article  Google Scholar 

  49. Graves CE, Moyer J, Zobel MJ, et al. Intraoperative intercostal nerve cryoablation during the Nuss procedure reduces length of stay and opioid requirement: a randomized clinical trial. J Pediatr Surg. 2019;54(11):2250–6. https://doi.org/10.1016/j.jpedsurg.2019.02.057.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lexicomp Online. Morphine (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  51. Lexicomp Online. Fentanyl (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  52. Lexicomp Online. Acetaminophen (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  53. Lexicomp Online. Ropivacaine (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  54. Lexicomp Online. Ketamine (Lexi-drugs). Hudson: Wolters Kluwer Clinical Drug Information; 2020. Accessed 27 Mar 2020.

    Google Scholar 

  55. Smeland AH, Rustoen T, Naess T, et al. Children’s views on postsurgical pain in recovery units in Norway: a qualitative study. J Clin Nurs. 2019;28(11–12):2157–70. https://doi.org/10.1111/jocn.14788.

    Article  PubMed  Google Scholar 

  56. Gall O, Champigneulle B, Schweitzer B, et al. Postoperative pain assessment in children: a pilot study of the usefulness of the analgesia nociception index. Br J Anaesth. 2015;115(6):890–5. https://doi.org/10.1093/bja/aev361.

    Article  CAS  PubMed  Google Scholar 

  57. Kaminsky O, Fortier MA, Jenkins BN, et al. Children and their parents’ assessment of postoperative surgical pain: agree or disagree? Int J Pediatr Otorhinolaryngol. 2019;123:84–92. https://doi.org/10.1016/j.ijporl.2019.04.005.

    Article  PubMed  Google Scholar 

  58. Short HL, Heiss KF, Burch K, et al. Implementation of an enhanced recovery protocol in pediatric colorectal surgery. J Pediatr Surg. 2018;53(4):688–92. https://doi.org/10.1016/j.jpedsurg.2017.05.004.

    Article  PubMed  Google Scholar 

  59. Peutrell JM, McIlveney S. Peripheral local anaesthetic techniques for paediatric surgery. Anaesth Intensive Care Med. 2003;4(12):407–11. https://doi.org/10.1383/anes.4.12.407.27390.

    Article  Google Scholar 

  60. Belvis D, Voronov P, Suresh S. Head and neck blocks in children. Reg Anesth Pain Med. 2007;11(4):208–14. https://doi.org/10.1053/j.trap.2007.09.009.

    Article  Google Scholar 

Download references

Financial Disclosures

None.

Conflicts of Interest

None.

Author information

Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Kimberly K. Coca, Andrew J. Maroda & Anthony M. Sheyn

  2. Division of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Regan F. Williams

  3. Department of Pediatric Surgery, Le Bonheur Children’s Hospital, Memphis, TN, USA

    Regan F. Williams

  4. Department of Pediatric Anesthesiology, Le Bonheur Children’s Hospital, Memphis, TN, USA

    Timothy A. Head

  5. Department of Pediatric Otolaryngology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Anthony M. Sheyn

  6. Department of Pediatric Otolaryngology, Le Bonheur Children’s Hospital, Memphis, TN, USA

    Anthony M. Sheyn

Authors
  1. Kimberly K. Coca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew J. Maroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Regan F. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timothy A. Head
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anthony M. Sheyn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony M. Sheyn .

Editor information

Editors and Affiliations

  1. Bergen Medical Associates, Emerson, NJ, USA

    Peter F. Svider

  2. Anesthesiology, Pain Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Anna A. Pashkova

  3. Otolaryngology – Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Andrew P. Johnson

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Coca, K.K., Maroda, A.J., Williams, R.F., Head, T.A., Sheyn, A.M. (2021). Perioperative Analgesia and Pain Management in Pediatric Patients. In: Svider, P.F., Pashkova, A.A., Johnson, A.P. (eds) Perioperative Pain Control: Tools for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-56081-2_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-56081-2_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-56080-5

  • Online ISBN: 978-3-030-56081-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation