Prevention and Treatment of Postoperative Pain with Particular Reference to Children

Treatment of Pain in Children after Limb-Sparing Surgery: An Institution's 26-Year Experience

“…Specific postoperative pain syndromes after orthopedic surgery have been described, and the efficacy of a variety of multimodal analgesic techniques have been examined (Chiaretti & Langer, 2005; Kost-Byerly, 2002; Pasero & McCaffery, 2007; Sumpelmann & Munte, 2003; Verghese & Hannallah, 2005). …”

“…Opioids remain the most important class of medications for relief of moderate to severe postoperative pain (Chiaretti & Langer, 2005; Pasero & McCaffery, 2007). In our review, oral short acting and long acting opioids were used in 60.3% and 48.3% of patients respectively, while intravenous opioids were used via PCA or non-PCA in 58.9% and 93.4% of patients respectively.…”

“…Importantly, optimal opioid dosing is based on the temporal characteristics of pain. For intermittent episodic pain, patients use as-needed or around-the-clock doses of oral immediate-release opioids or intravenous (IV) opioids, whereas for continuous pain, continuous IV infusions, PCA, or oral long-acting opioids, plus additional breakthrough doses, are recommended (Chiaretti & Langer, 2005; Pasero & McCaffery, 2007; Rosenquist & Rosenberg, 2003). Short-acting opioids are used for immediate management of breakthrough pain and even NP episodes (in the context of an anticonvulsant and/or TCA regimen) (Eisenberg, McNicol, & Carr, 2005).…”

“…Short-acting opioids are used for immediate management of breakthrough pain and even NP episodes (in the context of an anticonvulsant and/or TCA regimen) (Eisenberg, McNicol, & Carr, 2005). Children 5 years or older who are expected to experience moderate to severe pain for at least 24 hours can benefit from PCA analgesia; it can also be safely used for younger children with the assistance of nurses or family members educated on the use of PCA (Anghelescu, Burgoyne, Oakes, & Wallace, 2005; Chiaretti & Langer, 2005; Kost-Byerly, 2002; Wuhrman et al, 2007). PCA pumps were initiated at St. Jude in 1989.…”

Adjunctive Pain Control Methods Lower Narcotic Use and Pain Scores for Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion

“…Several alternative pain control strategies have been developed to improve outcomes, including on-demand patient controlled analgesia (PCA) pumps, intrathecal and epidural analgesia, intravenous ketorolac, local anesthetic infusions via indwelling catheters, and dexmedetomidine (DEX) (a centrally acting a2-adrenergic agonist similar to clonidine) infusions [7][8][9][10]. Anecdotally, providers observed improvement in pain control with the implementation of these adjunct therapies [11,12]. However, few studies are available that corroborate these observations.…”