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Postoperative analgesia in infants and children

机译：婴幼儿术后镇痛

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Although postoperative analgesia in infants and children should be an integral part of the perioperative management, undertreatment of pain is not rare in clinical practice and may influence outcome and long term behaviour. Therefore, this review summarizes results of recent papers and discusses actual trends and future perspectives concerning postoperative pharmacologic pain therapy in infants and children.A multimodal approach using locoregional anesthesia and systemic analgesics is a widely accepted technique. New developments include new local anesthetics with a wider margin of safety and more experience with adjuvants, catheter techniques and systemic analgesics. Replacement of bupivacaine with ropivacaine may be prudent especially for prolonged epidural infusion, use in neonates, impaired hepatic metabolic function, and anesthetic techniques requiring large dosage of local anesthetic. The limited duration of analgesia after single blocks can be prolonged by use of adjuvants (clonidine, ketamine), catheter techniques or early use of systemic analgesics. Non-opioids (acetaminophen, non-steroidal anti-inflammatory drugs) are appropriate for patients with mild to moderate pain or as a component of multimodal pain therapy. Patient- and nurse-controlled analgesia are convenient ways for opioid administration in infants and children.The reviewed studies suggest that there are many reliable agents and techniques available to provide a safe and effective postoperative analgesia even in neonates and small infants.
机译：尽管婴儿和儿童的术后镇痛应作为围手术期管理的组成部分，但在临床实践中对疼痛的不当治疗并不罕见，并且可能会影响预后和长期行为。因此，本综述总结了最近的论文结果，并讨论了有关婴幼儿术后药理疼痛治疗的实际趋势和未来展望。使用局部麻醉和全身镇痛的多峰方法是一种被广泛接受的技术。新的发展包括新的局部麻醉剂，其安全性范围更大，并且在佐剂，导管技术和全身镇痛剂方面有更多的经验。用罗哌卡因代替布比卡因可能是谨慎的，尤其是对于长时间的硬膜外输注，在新生儿中使用，肝代谢功能受损和需要大剂量局麻药的麻醉技术。通过使用佐剂（可乐定，氯胺酮），导管技术或早期使用全身性镇痛药可以延长单次阻滞后有限的镇痛时间。非阿片类药物（对乙酰氨基酚，非甾体类抗炎药）适用于轻度至中度疼痛或作为多模式疼痛治疗的一部分的患者。病人和护士控制的镇痛是婴儿和儿童使用阿片类药物的简便方法。综述研究表明，即使在新生儿和婴儿中，也有许多可靠的药物和技术可提供安全有效的术后镇痛。

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