| Dolor pediátrico despues de cirugía ambulatoria: ¿Donde está la medicación? |
Pediatric pain after ambulatory surgery: where's the medication?
Fortier MA, MacLaren JE, Martin SR, Perret-Karimi D, Kain ZN.
Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA. mfortier@choc.org
Abstract
Pediatrics. 2009 Oct;124(4):e588-95. Epub 2009 Sep 7.
OBJECTIVE: The purpose of this controlled study was to provide a description of children's postoperative pain, including pain intensity and analgesic consumption. METHODS: Participants included 261 children, 2 to 12 years of age, undergoing routine tonsillectomy and adenoidectomy surgery. Baseline and demographic data were collected before surgery, and a standardized approach to anesthesia and surgical procedures was used. Pain and analgesic consumption were recorded for 2 weeks at home. RESULTS: On the first day at home, although parents rated 86% of children as experiencing significant overall pain, 24% of children received 0 or just 1 medication dose throughout the entire day. On day 3 after surgery, although 67% of children were rated by parents as experiencing significant overall pain, 41% received 0 or 1 medication dose throughout the entire day. CONCLUSIONS: We conclude that a large proportion of children receive little analgesic medication after surgery and research efforts should be directed to the discrepancy between high ratings of postoperative pain provided by parents and the low dosing of analgesics they use for their children
http://pediatrics.aappublications.org/content/124/4/e588.full.pdf+html |
| Guías para el dolor por procedimientos en el recién nacido |
Guidelines for procedural pain in the newborn.
Lago P, Garetti E, Merazzi D, Pieragostini L, Ancora G, Pirelli A, Bellieni CV; Pain Study Group of the Italian Society of Neonatology.
Collaborators (6)
Allegro A, Cavazza A, Cocchi G, Giusti F, Guadagni A, Memo L.
Neonatal Intensive Care Unit, Department of Paediatrics, University of Padova, Via Giustiniani 3, Padua, Italy. lago@pediatria.unipd.it
Acta Paediatr. 2009 Jun;98(6):932-9.
Abstract
Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure. There is strong evidence to support some analgesic measures, e.g. sucrose or breast milk for minor invasive procedures, and combinations of drugs for tracheal intubation. Many other pain control measures used during chest tube placement and removal, screening and treatment for ROP, or for postoperative pain, are still based not on evidence, but on good practice or expert opinions. CONCLUSION: These guidelines should help improving the health care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688676/pdf/apa0098-0932.pdf |
| Evaluación del dolor postoperatorio en neonates: estudio multicéntrico observacional |
Assessing postoperative pain in neonates: a multicenter observational study.
Taylor BJ, Robbins JM, Gold JI, Logsdon TR, Bird TM, Anand KJ.
Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas 72202, USA.
Pediatrics. 2006 Oct;118(4):e992-1000.
Abstract
OBJECTIVE: A multicenter observational study was conducted to evaluate the practices of postoperative pain assessment and management in neonates to identify specific targets for improvement in clinical practice. METHODS: Ten participating NICUs collected data for the 72 hours after a surgical operation on 25 consecutive neonates (N = 250), including demographics, principal diagnoses, operative procedure, other painful procedures, pain assessments, interventions (pharmacologic and nonpharmacologic), and adverse events in neonates who underwent minor and major surgery. Descriptive and logistic-regression analyses were performed by using SPSS and Stata. RESULTS: The neonates studied had a birth weight of 2.4 +/- 1.0 kg (mean +/- SD) and gestational age of 36 +/- 4.3 weeks; 57% were male, and length of hospital stay was 23.5 +/- 30.0 days. Participating hospitals used 7 different numeric pain scales, with nursing pain assessments documented for 88% (n = 220) of the patients and physician pain assessments documented for 9% (n = 23) of the patients. Opioids (84% vs 60%) and benzodiazepines (24% vs 11%) were used more commonly after major surgery than minor surgery, and a small proportion (7% major surgery, 12% minor surgery) received no analgesia. Logistic-regression analyses showed that physician pain assessment was the only significant predictor of postsurgical analgesic use, whereas major surgery and postnatal age in days did not seem to contribute. Physician pain assessment was documented for 23 patients; 22 of these received postoperative analgesia. CONCLUSIONS: Documentation of postoperative pain assessment and management in neonates was extremely variable among the participating hospitals. Pain assessment by physicians must be emphasized, in addition to developing evidence-based guidelines for postoperative care and educating professional staff to improve postoperative pain control in neonates.
http://pediatrics.aappublications.org/content/118/4/e992.full.pdf+html
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| Analgésicos Antiinflamatorios No Esteroideos en el Niño |
Dr. Enrique Hernández Cortez
Anestesiólogo Pediatra. Jefe del Departamento de Anestesiología. Hospital de Alta Especialidad
Instituto Mexicano del Seguro Social. León Guanajuato, México.kikinhedz@gmail.com
Anestesia en México 2006;18:28-28
El tratamiento del dolor y el sufrimiento deben de ser prioridades para todos los clínicos. Revisiones científicas previas detectaron un inadecuado tratamiento de dolor en infantes y niños, aunque el dolor ocurre en todas las sociedades y edades, y representa el síntoma más común por el cual el paciente solicita asistencia médica. Los analgésicos no esteroideos se usan con frecuencia en el tratamiento del dolor agudo por tiempos cortos, principalmente para tratar y prevenir el dolor leve a moderado, que junto con los opioides, proporcionan mejores resultados. El énfasis de esta revisión es sobre el manejo farmacológico del dolor agudo con analgésicos no esteroideos. Durante la última década el clínico ha tenido un mayor entendimiento de los mecanismos fisiopatológicos del daño tisular y control del dolor postoperatorio, lo cual les ha dado a los clínicos un uso racional de analgesia balanceada postoperatoria. El daño tisular periférico y la hipersensibilización de las astas anteriores de la medula espinal, son probablemente de mayor significancia clínica. Los analgésicos no esteroideos juegan un papel importante en una parte del tratamiento del dolor postoperatorio, en el bloqueo de la hipersensibilización de las astas anteriores de la medula espinal, y son muy efectivos en combinación con bloqueo de nervios regionales o locales, particularmente en cirugía ambulatoria. Recientemente varios inhibidores de la COX-2 han sido evaluados en el paciente pediátrico y los estudios muestran igual eficacia con otros analgésicos, incluyendo analgésicos no esteroideos, o el acetaminofen cuando son usados para tratamiento de dolor postoperatorio, estos incluyen una reducción significativa en la incidencia de ulcera gastrointestinal, acciones inhibidoras sobre las plaquetas y reducido riesgo de sangrado, o pérdida de sangre. Otros beneficios son menos importantes, como el retardo en la cicatriz ósea y no inducir un episodio de broncoespasmo en pacientes sensibles al asma. Su papel en el niño es limitado y menos definido aun, ya tan solo con un pequeño número de estudios han evaluado su importancia en el niño.
Palabras clave: Analgésicos antiinflamatorios no esteroides, pediatría.
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