PERSONAL PRACTICE Preoperative and postoperative pain control

Interest in pain management for children in the perioperative period has increased substantially in the past few years and this has led to very significant changes in this area of clinical practice. The quality of pain control that can be achieved is more often a function of the time and resources devoted to it, rather than the actual regimens employed. A well coordinated multidisciplinary approach will achieve the best results and 'acute pain control teams' are being established in many hospitals with this aim. Acute pain treatment in children is subject to special problems because they are such a diverse population. The response to analgesics varies with age and side effects are often unpredictable. Pain is difficult to assess in preverbal children which further complicates its management. Fortunately there have been a number of advances recently that have allowed improvements in pain management. The mechanisms of pain transmission are more completely understood, the pharmacokinetics and pharmacodynamics of analgesic drugs in small children have been described, and new techniques of pain control have come into practice.