Pharmacologic Management of Acute Pediatric Pain

Kraemer, F. Wickham; Rose, John B.

doi:10.1016/j.anclin.2009.07.002

Cited by 109 publications

(15 citation statements)

References 142 publications

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“…The binding of morphine to proteins is also decreased, allowing a larger proportion of drug free fraction to penetrate the brain, increasing the risk of respiratory depression. On the other hand, at two months of age half-life and plasma clearance values are equal to those of adults, so it is necessary to carefully titrate the agent to obtain desirable levels of analgesia without adverse effects 20 . Preterm neonates produce more metabolites (morphine-3-gicuronide) than older children, and for being antagonist metabolite, neonates may develop tolerance three or four days after starting treatment 21 .…”

Section: Morphinementioning

confidence: 99%

“…Care must be taken because after five or more days of fentanyl continuous infusion there may be tolerance or withdrawal syndrome. Neonates, for having decreased levels of acid glycoprotein α-1, protein to which the opioid normally binds, have more fentanyl plasma free fraction 7,20 . Studies with neonates using intravenous fentanyl during MV have observed decreased pain scores, stress and heart rate, as compared to placebo, in addition to increased growth hormone levels 26 .…”

Section: Fentanylmentioning

confidence: 99%

“…. Tramadol and codeine: weak opioids with wide pharmacogenetic variability with regard to metabolization and equal or higher incidence of nausea and vomiting as compared to strong opioids 20 . Methadone and nalbuphine for postoperative analgesia: little evidence of their use in children 20 .…”

Section: Fentanylmentioning

confidence: 99%

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Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly

2014

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BACKGROUND AND OBJECTIVES: Pain management in age extremes and in children still requires attention and paradigms review. There are several diseases or procedures inducing pain from the neonatal period to adolescence. In the elderly, there is higher prevalence of degenerative diseases which induce acute and chronic pain. This study aimed at discussing recommendations for the use of opioid in neonates, children and the elderly. CONTENTS:This review has addressed the use of opioids in the neonatal period, in older children and in the elderly, their indications, drugs used, doses, risks, complications and recommendations. CONCLUSION: The use of opioids in age extremes is still a challenge. However, ongoing education about the subject is needed, encouraging clinical trials and the development of evidence-based recommendations. The safe use of such agents in correct indication and proportion for pain relief decreases risks and should be the basis for good clinical practice. Keywords: Children, Elderly, Opioids. RESUMO JUSTIFICATIVA E OBJETIVOS:

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Section: Morphinementioning

confidence: 99%

Section: Fentanylmentioning

confidence: 99%

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Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly

2014

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“…But we can decrease their use by addition of other analgesics and use of techniques that target other parts of pain pathways and obtain an equal or even greater analgesia. Thus, decreasing adverse effects of opioids like nausea, vomiting, constipation, itching, respiratory depression and urinary retention (3).It should be noted that use of opioids in infants younger than 4 -6 months can cause apnea and hypoventilation (2). Caudal anesthesia is the oldest and at present the most common epidural technique in children (4).Single dose injection in caudal anesthesia is the most effective and most prevalent form of regional block in children.…”

Section: Introductionmentioning

confidence: 99%

Addition of Clonidine in Caudal Anesthesia in Children Increases Duration of Post-Operative Analgesia

Lak¹,

Araghizadeh²,

Shayeghi³

et al. 2012

Trauma Mon

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Implication for health policy/practice/research/medical education:The results of this study showed post-operative pain management in pediatric patients was enhanced when clonidine was added to the drug regimen. Objectives: In this study we examined the duration of post-operative analgesia in children when clonidine is added to bupivacaine in caudal anesthesia. A R T I C L E I N F O A B S T R A C T Materials and Methods:In this clinical trial, 40 children aged 1-8 years who were candidates for elective inguinal hernia repair were studied. Induction and maintenance of anesthesia were achieved using sodium thiopenthal, halothane and nitrous oxide. Children were randomly divided into 2 groups in a double-blind fashion, and were given caudal anesthesia with 0.125% bupivacaine (1ml/kg) alone or b bupivacaine plus 2 µg/kg clonidine. Blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated using objective pain scale (OPS) and sedation was assessed using Ramsay sedation scale (RSS). Acetaminophen was administered rectally for cases with OPS score greater than five.Results: Duration of analgesia was found to be significantly longer in the group given bupivacaine plus clonidine (mean 417.50 min vs. 162.00 min). Peri-operative hypotension or bradycardia, post-operative respiratory depression, nausea or vomiting were not recorded in any patient. Conclusions:We concluded that addition of clonidine to bupivacaine prolongs the duration of post-operative analgesia without any respiratory or hemodynamic side-effects.

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Section: Introductionmentioning

confidence: 99%

Addition of Clonidine in Caudal Anesthesia in Children Increases Duration of Post-Operative Analgesia

Lak¹,

Araghizadeh²,

Shayeghi³

et al. 2011

Trauma Mon

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Background:Pain in infancy is a developmental process. Due to the underdeveloped pain pathways in the spinal cord, the threshold of stimulation and sensation of pain is low at birth and has potential impacts on increasing the central effects of pain. Primary trauma during infancy can cause long term changes in structure and function of pain pathways that continue until adulthood. Lack of pain management in children can result in morbidity and mortality.Objectives:In this study we examined the duration of post-operative analgesia in children when clonidine is added to bupivacaine in caudal anesthesia.Materials and Methods:In this clinical trial, 40 children aged 1-8 years who were candidates for elective inguinal hernia repair were studied. Induction and maintenance of anesthesia were achieved using sodium thiopenthal, halothane and nitrous oxide. Children were randomly divided into 2 groups in a double-blind fashion, and were given caudal anesthesia with 0.125% bupivacaine (1ml/kg) alone or b bupivacaine plus 2 μg/kg clonidine. Blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated using objective pain scale (OPS) and sedation was assessed using Ramsay sedation scale (RSS). Acetaminophen was administered rectally for cases with OPS score greater than five.Results:Duration of analgesia was found to be significantly longer in the group given bupivacaine plus clonidine (mean 417.50 min vs. 162.00 min).Peri-operative hypotension or bradycardia, post-operative respiratory depression, nausea or vomiting were not recorded in any patient.Conclusions:We concluded that addition of clonidine to bupivacaine prolongs the duration of post-operative analgesia without any respiratory or hemodynamic side-effects.

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Pharmacologic Management of Acute Pediatric Pain

Cited by 109 publications

References 142 publications

Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly

Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly

Addition of Clonidine in Caudal Anesthesia in Children Increases Duration of Post-Operative Analgesia

Addition of Clonidine in Caudal Anesthesia in Children Increases Duration of Post-Operative Analgesia

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