Perioperative pain management

Abstract Assessment and treatment of pain are fundamental skills required by all doctors, but particularly by those caring for the child with an acute surgical condition or trauma. An understanding of the physiological and pharmacological changes that occur during growth and maturation from birth to young adulthood is necessary for safe prescribing of even simple analgesics. Multimodal analgesia combines non-pharmacological techniques with local or regional analgesia, simple analgesics, and opioid drugs to optimize pain relief and reduce side effects by using the minimum effective doses. Perioperative care involves procedures that are painful or frightening for many children; distress can be ameliorated by careful discussion and planning with use of simple distraction techniques and appropriate analgesia. Complex analgesic regimens, such as epidural infusions, patient-controlled analgesia, and nurse-controlled analgesia, are frequently used in collaboration with an acute pain service following major surgery.