Perioperative Pain Control in Pediatric Patients Undergoing Orthopaedic Surgery

&NA; Management of perioperative pain is critical in the pediatric patient undergoing orthopaedic surgery. A variety of modalities can be used to manage pain and optimize recovery and patient satisfaction, including nonopioid and opioid analgesia; local anesthetic injection; and regional analgesia such as intrathecal morphine, epidural therapy, and peripheral nerve blocks. Acute pain management can be tailored based on the needs of the patient, the surgical site, and the anticipated level of postoperative pain. A preoperative discussion of the plan for perioperative pain control with the patient, his or her parents, and the anesthesiologist can help manage expectations and maximize patient satisfaction.

[1]  E. Viscusi,et al.  Intravenous Acetaminophen for Pain after Major Orthopedic Surgery: An Expanded Analysis , 2012, Pain practice : the official journal of World Institute of Pain.

[2]  J. Wispé,et al.  Safety of ketorolac in surgical neonates and infants 0 to 3 months old. , 2011, Journal of pediatric surgery.

[3]  G. Haller,et al.  Morbidity in anaesthesia: today and tomorrow. , 2011, Best practice & research. Clinical anaesthesiology.

[4]  A. Yılmazlar,et al.  The effect of local anaesthetic on post-operative pain with wound instillation via a catheter for paediatric orthopaedic extremity surgery , 2011, Journal of children's orthopaedics.

[5]  R. Kay,et al.  Complications of Ketorolac Use in Children Undergoing Operative Fracture Care , 2010, Journal of pediatric orthopedics.

[6]  William F Lavelle,et al.  Epidural Analgesia for Postoperative Pain Control After Adolescent Spinal Fusion Procedures Which Violated the Epidural Space , 2010, Journal of spinal disorders & techniques.

[7]  J. Son-Hing,et al.  Continuous Intravenous Morphine Infusion for Postoperative Analgesia Following Posterior Spinal Fusion for Idiopathic Scoliosis , 2010, Spine.

[8]  C. Clark,et al.  Efficacy of postoperative epidural analgesia in adolescent scoliosis surgery: a meta‐analysis , 2010, Paediatric anaesthesia.

[9]  B. Tsui,et al.  Evidence-Based Medicine: Assessment of Ultrasound Imaging for Regional Anesthesia in Infants, Children, and Adolescents , 2009, Regional Anesthesia & Pain Medicine.

[10]  T. Voepel-Lewis,et al.  Epidural Analgesia Compared With Intravenous Analgesia After Pediatric Posterior Spinal Fusion , 2009, Journal of pediatric orthopedics.

[11]  B. Bissonnette,et al.  The use of NSAIDs in pediatric scoliosis surgery – a survey of physicians’ prescribing practice , 2009, Paediatric anaesthesia.

[12]  T. Milbrandt,et al.  A Comparison of Three Methods of Pain Control for Posterior Spinal Fusions in Adolescent Idiopathic Scoliosis , 2009, Spine.

[13]  S. Sadhasivam,et al.  Are peripheral and neuraxial blocks with ultrasound guidance more effective and safe in children? , 2009, Paediatric anaesthesia.

[14]  N. Naccache,et al.  Combined regional and general anesthesia for ambulatory peripheral orthopedic surgery in children , 2009, Journal of pediatric orthopedics. Part B.

[15]  J. Son-Hing,et al.  Intrathecal Morphine for Postoperative Analgesia in Patients With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion , 2008, Spine.

[16]  J. Lovejoy,et al.  Postoperative Ketorolac Does Not Predispose to Pseudoarthrosis Following Posterior Spinal Fusion and Instrumentation for Adolescent Idiopathic Scoliosis , 2008, Spine.

[17]  C. Keller,et al.  Comparison of high- and low-dose intrathecal morphine for spinal fusion in children. , 2008, British journal of anaesthesia.

[18]  A. Ganesh,et al.  Low-Dose Intrathecal Morphine for Postoperative Analgesia in Children , 2007, Anesthesia and analgesia.

[19]  M. James,et al.  Regional Techniques as an Adjunct to General Anesthesia for Pediatric Extremity and Spine Surgery , 2006, Journal of pediatric orthopedics.

[20]  K. Barrington,et al.  Prevention and Management of Pain in the Neonate: An Update , 2006, Pediatrics.

[21]  Dorothy Syblik,et al.  Pediatric anxiety: child life intervention in day surgery. , 2006, Journal of pediatric nursing.

[22]  J. Rathmell,et al.  The Role of Intrathecal Drugs in the Treatment of Acute Pain , 2005, Anesthesia and analgesia.

[23]  N. Morton,et al.  Postoperative analgesia in infants and children. , 2005, British journal of anaesthesia.

[24]  E. Viscusi,et al.  Efficacy and Safety of Single and Repeated Administration of 1 Gram Intravenous Acetaminophen Injection (Paracetamol) for Pain Management after Major Orthopedic Surgery , 2005, Anesthesiology.

[25]  D. Sucato,et al.  Postoperative Analgesia Following Surgical Correction for Adolescent Idiopathic Scoliosis: A Comparison of Continuous Epidural Analgesia and Patient-Controlled Analgesia , 2005, Spine.

[26]  Meng Xu,et al.  The effect of epidural vs intravenous analgesia for posterior spinal fusion surgery , 2004, Paediatric anaesthesia.

[27]  Susan L. Foad,et al.  Hematoma Block Reduces Narcotic Pain Medication After Femoral Elastic Nailing in Children , 2004, Journal of pediatric orthopedics.

[28]  J. Tobias A Review of Intrathecal and Epidural Analgesia After Spinal Surgery in Children , 2004, Anesthesia and analgesia.

[29]  B. Allaouchiche,et al.  Patient-Controlled Epidural Analgesia Versus Continuous Epidural Infusion with Ropivacaine for Postoperative Analgesia in Children , 2003, Anesthesia and analgesia.

[30]  X. Capdevila,et al.  Perioperative Continuous Peripheral Nerve Blocks with Disposable Infusion Pumps in Children: A Prospective Descriptive Study , 2003, Anesthesia and analgesia.

[31]  T. Voepel-Lewis,et al.  Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[32]  R. Gaines,et al.  Postoperative Pain Control Using Epidural Catheters After Anterior Spinal Fusion for Adolescent Scoliosis , 2001, Spine.

[33]  I. Murat,et al.  Analgesic Effect of Low-dose Intrathecal Morphine after Spinal Fusion in Children , 2001, Anesthesiology.

[34]  R. Gaines,et al.  A dual epidural catheter technique to provide analgesia following posterior spinal fusion for scoliosis in children and adolescents , 2001, Paediatric anaesthesia.

[35]  Michael J. Curtin,et al.  A Comparison of the Effects of Patient-Controlled Analgesia with Intravenous Opioids Versus Epidural Analgesia on Recovery After Surgery for Idiopathic Scoliosis , 2000, Spine.

[36]  R. Wetzel,et al.  The Safety and Efficacy of Parent-/Nurse-Controlled Analgesia in Patients Less than Six Years of Age , 2000, Anesthesia and analgesia.

[37]  G. Lederhaas,et al.  A Randomized Comparison of the Effects of Continuous Thoracic Epidural Analgesia and Intravenous Patient‐Controlled Analgesia After Posterior Spinal Fusion in Adolescents , 2000, Regional anesthesia and pain medicine.

[38]  G. Edge,et al.  The efficacy of surgically placed epidural catheters for analgesia after posterior spinal surgery , 2000, Anaesthesia.

[39]  T. Brown,et al.  Anaesthesia and pain management in cerebral palsy , 2000, Anaesthesia.

[40]  M. Ehrlich,et al.  The role of ketorolac in decreasing length of stay and narcotic complications in the postoperative pediatric orthopaedic patient. , 1999, Journal of pediatric orthopedics.

[41]  J. T. Smith,et al.  Postoperative epidural analgesia for pediatric spine surgery. , 1998, Orthopedics.

[42]  M. Goodarzi The advantages of intrathecal opioids for spinal fusion in children , 1998, Paediatric anaesthesia.

[43]  K. Brown,et al.  Compartment syndrome associated with bupivacaine and fentanyl epidural analgesia in pediatric orthopaedics. , 1997, Journal of pediatric orthopedics.

[44]  B. Dalens,et al.  Epidemiology and Morbidity of Regional Anesthesia in Children: A One-Year Prospective Survey of the French-Language Society of Pediatric Anesthesiologists , 1996, Anesthesia and analgesia.

[45]  J. Cravero,et al.  Regional Anesthesia in Infants, Children, and Adolescents , 1996 .

[46]  B. Shaw,et al.  The safety of continuous epidural infusion for postoperative analgesia in pediatric spine surgery. , 1996, Journal of pediatric orthopedics.

[47]  J. Lerman,et al.  A Practice of Anesthesia for Infants and Children , 1993 .

[48]  P. White,et al.  Comparison of ketorolac and morphine as adjuvants during pediatric surgery. , 1992, Anesthesiology.

[49]  C. Berde,et al.  Patient-controlled analgesia in children and adolescents: a randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia. , 1991, The Journal of pediatrics.

[50]  J. Andrish,et al.  Efficacy of intermittent epidural morphine following posterior spinal fusion in children and adolescents. , 1989, Clinical orthopaedics and related research.

[51]  A. Tanguy,et al.  Intrathecal Morphine for Spinal Fusion in Children , 1988, Spine.

[52]  F. Magora,et al.  EPIDURAL MORPHINE IN TREATMENT OF PAIN , 1979, The Lancet.

[53]  W. Sacks,et al.  Letter: Ascorbic acid in levodopa therapy. , 1975, Lancet.

[54]  S. Black Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters , 2010 .

[55]  C. V. von Baeyer,et al.  Children's self-reports of pain intensity: scale selection, limitations and interpretation. , 2006, Pain research & management.

[56]  F. Reinoso-Barbero,et al.  Lidocaine with fentanyl, compared to morphine, marginally improves postoperative epidural analgesia in children , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[57]  L. Broadman Regional Anesthesia in Infants, Children, and Adolescents , 1997 .