Managing Pediatric Pain in the Emergency Department

Abstract

Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.

Dexmedetomidine with magnesium sulphate as adjuvants in caudal block to augment anaesthesia and analgesia in paediatric lower abdominal surgeries

“…Each adjuvant in our study is well-known to be unique in its mechanism of action, safe, and can prolong the pain-free period. It is evident that neuraxial dexmedetomidine exerts analgesia by inhibiting spinal microglial and astrocytes activation, depressing the release of nociceptive substances, interrupting spinal neuro-glial cross action; hence, regulating the nociceptive transmission [1][2][3][4]. These antinociceptive effects of intrathecal dexmedetomidine are dose-dependent [5,6].…”

“…Postoperative pain in children is difficult to be assessed and associated with a strong emotional component. Caudal epidural anaesthesia is a common technique which can provide both intra and postoperative analgesia in paediatric surgeries [1]. Prolongation of caudal analgesia can be achieved by the addition of various adjuvants such as opioids, ketamine, α 2 -adrenoceptors agonists, and opioids [2][3][4].…”

Assessment of orofacial pain management in a pediatric emergency department and at home after discharge

“…4,5 Health care providers from the e m e r g e n c y d e p a r t m e n t s h o u l d recognize and treat pain promptly. 6 To this end, first it is necessary to identify and assess pain intensity using scales based on age and cognitive level. 7 Then, a drug should be selected according to the type of pain and its intensity, side effects, concomitant conditions, and administration route.…”

Evaluación del manejo del dolor de la patología facial y oral en un Servicio de Urgencias Pediátrico y tras el alta domiciliaria

“…4,5 Los profesionales de la salud del Servicio de Urgencias deben reconocer y tratar el dolor con prontitud. 6 Para ello, primero, se ha de identificar y evaluar su intensidad usando escalas según la edad y el estado cognitivo. 7 Posteriormente, elegir el fármaco según el tipo e intensidad del dolor, efectos secundarios, patologías concomitantes y vía de administración.…”