Literature Review
Analgesics For the Treatment of Pain in Children.
Berde CB, Sethna NF. New Engl J Med 347;1094-1103,2002
This is an excellent general review of pain management in children aimed primarily at non-anesthesiologist physicians. Drs Berde and Sethna review the basic development of nociception, stressing the fact that most studies show that peripheral, spinal and supraspinal pain afferents are present and functional by 26 weeks gestational age. They also discuss studies that reveal the potential negative consequences of untreated pain in neonates. Developmental issues in pain assessment and pharmacology are nicely summarized. There is a table that reviews the age related physiologic trends relevant to analgesic drug action. For example plasma protein binding, renal clearance and hepatic metabolism of the neonate compared to the infant and adult are presented and their clinical implications discussed.
The use and suggested dosing for different types of medications (acetaminophen, opioids, nonsteroidal anti-inflammatory drugs, and local anesthetics) are presented. The use of Patient Controlled Analgesia (PCA) and Nurse controlled analgesia in children are reviewed as well as other routes of administration.
Finally there are brief sections on the use of general anesthesia for neonates and children (it is safe and should be used even in critically ill patients), treatment of pain due to cancer and chronic non-cancer pain.
Reviewer’s comments: This is an excellent review article that because of its source (NEJM) and its focus (other physicians who may come in contact with children in pain) may elicit questions or comments from your colleagues. There is no new information for those of use who deal with pediatric pain on a regular basis, but it may be new to non-anesthesiologists or anesthesiologist who care primarily for adults
Reviewed by: Rita Agarwal, MD #include ./footer_include.iphtml