sábado, 26 de octubre de 2013

Dolor en niños/Children pain

Manejo del dolor agudo en niños  
Acute pain management in children.
Verghese ST, Hannallah RS.
The George Washington University Medical Center, Division of Anesthesiology, Children's National Medical Center, Washington, DC, USA.
J Pain Res. 2010 Jul 15;3:105-23.
The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain is constantly being refined; with newer drugs being used alone or in combination with other drugs continues to be explored. Several advances in developmental neurobiology and pharmacology, knowledge of new analgesics and newer applications of old analgesics in the last two decades have helped the pediatricanesthesiologist in managing pain in children more efficiently. The latter include administering opioids via the skin and nasal mucosa and their addition into the neuraxial local anesthetics. Systemic opioids, nonsteroidal anti-inflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined as a multimodal approach to treat acute pain in the perioperative setting. The development of receptor specific drugs that can produce pain relief without the untoward side effects of respiratory depression will hasten the recovery and discharge of children after surgery. This review focuses on the overview of acute pain management in children, with an emphasis on pharmacological and regional anesthesia in achieving this goal.
KEYWORDS: epidural additives, pain medication in children, pca and pcea in children, pediatric pain treatment, pediatric regional anesthesia 

Eficacia analgésica postoperatoria de un dosis alta de acetaminofen rectal en cirugía oftalmológica en niños      
Postoperative analgesic efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery.
Gandhi R, Sunder R.
Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2012 Oct;28(4):460-4. doi: 10.4103/0970-9185.101906.
BACKGROUND: Analgesic efficacy of rectal acetaminophen is variable in different surgical procedures. Little data is available on its efficacy in ophthalmic surgeries. We conducted this prospective, randomized, double blind study to evaluate and compare the efficacy of single high dose and low dose rectal acetaminophen in pediatric ophthalmic surgery over a 24 hour period. MATERIALS AND METHODS: 135 children scheduled for elective ophthalmic surgery were randomly allocated to one of the three groups, high, low, or control (H, L, or N) and received rectal acetaminophen 40 mg/kg, 20 mg/kg or no rectal drug respectively after induction of general anesthesia.Postoperative observations included recovery score, hourly observational pain score (OPS) up to 8 hours, time to first analgesic demand, and requirement of rescue analgesics and antiemetics over a 24 hour period. RESULTS: Nineteen of 30 (63%) of children in group N required postoperative rescue analgesic versus 5/48 (10%) of group H (P <0.0001) and 10/47 (23%) of group L (P =0.0005) during 24 hour period. Mean time to requirement of first analgesic was 206±185 min in group H, 189±203min in group L, and 196 ±170 min in group N (P=0.985). OPS was significantly lower in group H and L compared to group N during first 8 hours. Requirement of rescue antiemetic was 18.7% in group H as compared to 23% each in group L and group N (P >0.5). CONCLUSIONS: Single dose rectal acetaminophen can provide effective postoperative analgesia for pediatric ophthalmic surgery at both high dose (40 mg/kg) and low dose (20 mg/kg) both in early postoperative and over a 24 hour period.
KEYWORDS: Postoperative analgesia, pediatric ophthalmic surgery, rectal acetaminophen
Una auditoría del manejo del dolor después de la cirugía ambulatoria pediátrica en el Hospital Infantil de Columbia Británica.             
An audit of pain management following pediatric day surgery at British Columbia Children's Hospital.
Shum S, Lim J, Page T, Lamb E, Gow J, Ansermino JM, Lauder G.
Queen's University, Canada.
Pain Res Manag. 2012 Sep-Oct;17(5):328-34.
A prospective audit of 225 children was conducted to evaluate current pain management strategies both in-hospital and at home following day surgery at British Columbia Children's Hospital (Vancouver, British Columbia). Anesthetic, postanesthetic care unit and surgical day care unit records were collected to generate in-hospital data. A telephone questionnaire was administered 48 h postdischarge for at home data. Pain reports and scores were significantly higher (P<0.01) at home compared with in-hospital. Children undergoing certain procedures were more likely to experience significant pain. Although good pain control was commonly achieved after surgery, improvements may be possible by increasing the use of multimodal analgesia, providing standardized written discharge instructions and using surgery-specific pediatric analgesia guidelines.
Anestesiología y Medicina del Dolor
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