Skip to main content
Top
Published in: Pediatric Drugs 11/2003

01-11-2003 | Therapy In Practice

Postoperative Pain Control in Children

A Guide to Drug Choice

Authors: Dr Eva Kokinsky, Eva Thornberg

Published in: Pediatric Drugs | Issue 11/2003

Login to get access

Abstract

Postoperative pain in children can usually be well controlled with a combination of analgesics, including acetaminophen (paracetamol), NSAIDs, opioids, and local/regional anesthesia. Recent research has shown that the dosage of acetaminophen required to provide analgesia is higher than the traditional dosages used for the regulation of elevated body temperature. Rectal administration of acetaminophen gives a lower and more variable bioavailability compared with oral administration. There is growing experience with the use of NSAIDs in children and several studies have demonstrated the relatively strong analgesic potential of these drugs. Titration of opioids to analgesic effect, and the use of nurse- and patient-controlled continuous opioid infusions in children have gained widespread use and, with proper education and supervision, are considered excellent methods of pain control. Local peripheral and central blocks decrease the need for anesthetics during surgery and provide effective postoperative pain relief.
Literature
1.
go back to reference Schechter N, Berde C, Yaster M, editors. Pain in infants, children and adolescents. Baltimore (MD): Williams & Wilkins, 1993 Schechter N, Berde C, Yaster M, editors. Pain in infants, children and adolescents. Baltimore (MD): Williams & Wilkins, 1993
2.
go back to reference McQuay HJ, Carroll D, Moore RA. Injected morphine in postoperative pain: a quantitative systematic review. J Pain Symptom Manage 1999; 17: 164–74PubMedCrossRef McQuay HJ, Carroll D, Moore RA. Injected morphine in postoperative pain: a quantitative systematic review. J Pain Symptom Manage 1999; 17: 164–74PubMedCrossRef
3.
go back to reference Montgomery JE, Sutherland CJ, Kestin IG, et al. Morphine consumption in patients receiving rectal paracetamol and diclofenac alone and in combination. Br J Anaesth 1996; 77: 445–7PubMedCrossRef Montgomery JE, Sutherland CJ, Kestin IG, et al. Morphine consumption in patients receiving rectal paracetamol and diclofenac alone and in combination. Br J Anaesth 1996; 77: 445–7PubMedCrossRef
4.
go back to reference Morton N, O’Brien K. Analgesic efficacy of paracetamol and diclofenac in children receiving PCA morphine. Br J Anaesth 1999; 82: 715–7PubMedCrossRef Morton N, O’Brien K. Analgesic efficacy of paracetamol and diclofenac in children receiving PCA morphine. Br J Anaesth 1999; 82: 715–7PubMedCrossRef
5.
go back to reference Anderson BJ. What we don’t know about paracetamol in children. Paediatr Anaesth 1998; 8: 451–60PubMedCrossRef Anderson BJ. What we don’t know about paracetamol in children. Paediatr Anaesth 1998; 8: 451–60PubMedCrossRef
6.
go back to reference Casteels-Van Daele M, Van Geet C, Wouters C, et al. Reye syndrome revisited: a descriptive term covering a group of heterogeneous disorders. Eur J Pediatr 2000; 159: 641–8PubMedCrossRef Casteels-Van Daele M, Van Geet C, Wouters C, et al. Reye syndrome revisited: a descriptive term covering a group of heterogeneous disorders. Eur J Pediatr 2000; 159: 641–8PubMedCrossRef
7.
go back to reference Anderson BJ, Holford NH, Woollard GA, et al. Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiology 1999; 90: 411–21PubMedCrossRef Anderson BJ, Holford NH, Woollard GA, et al. Perioperative pharmacodynamics of acetaminophen analgesia in children. Anesthesiology 1999; 90: 411–21PubMedCrossRef
8.
go back to reference Anderson BJ, van Lingen RA, Hansen TG, et al. Acetaminophen developmental pharmacokinetics in premature neonates and infants: a pooled population analysis. Anesthesiology 2002; 96: 1336–45PubMedCrossRef Anderson BJ, van Lingen RA, Hansen TG, et al. Acetaminophen developmental pharmacokinetics in premature neonates and infants: a pooled population analysis. Anesthesiology 2002; 96: 1336–45PubMedCrossRef
9.
go back to reference Granry JC, Rod B, Monrigal JP, et al. The analgesic efficacy of an injectable prodrug of acetaminophen in children after orthopaedic surgery. Paediatr Anaesth 1997; 7: 445–9PubMedCrossRef Granry JC, Rod B, Monrigal JP, et al. The analgesic efficacy of an injectable prodrug of acetaminophen in children after orthopaedic surgery. Paediatr Anaesth 1997; 7: 445–9PubMedCrossRef
10.
go back to reference van Lingen RA, Deinum JT, Quak JM, et al. Pharmacokinetics and metabolism of rectally administered paracetamol in preterm neonates. Arch Dis Child Fetal Neonatal Ed 1999; 80: F59–63PubMedCrossRef van Lingen RA, Deinum JT, Quak JM, et al. Pharmacokinetics and metabolism of rectally administered paracetamol in preterm neonates. Arch Dis Child Fetal Neonatal Ed 1999; 80: F59–63PubMedCrossRef
11.
go back to reference Penna A, Buchanan N. Paracetamol poisoning in children and hepatotoxicity. Br J Clin Pharmacol 1991; 32: 143–9PubMedCrossRef Penna A, Buchanan N. Paracetamol poisoning in children and hepatotoxicity. Br J Clin Pharmacol 1991; 32: 143–9PubMedCrossRef
12.
go back to reference Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatotoxicity after multiple doses in children. J Pediatr 1998; 132: 22–7PubMedCrossRef Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatotoxicity after multiple doses in children. J Pediatr 1998; 132: 22–7PubMedCrossRef
13.
go back to reference Arana A, Morton NS, Hansen TG. Treatment with paracetamol in infants. Acta Anaesthesiol Scand 2001; 45: 20–9PubMedCrossRef Arana A, Morton NS, Hansen TG. Treatment with paracetamol in infants. Acta Anaesthesiol Scand 2001; 45: 20–9PubMedCrossRef
14.
go back to reference Morton NS, Arana A. Paracetamol-induced fulminant hepatic failure in a child after 5 days of therapeutic doses. Paediatr Anaesth 1999; 9: 463–5PubMedCrossRef Morton NS, Arana A. Paracetamol-induced fulminant hepatic failure in a child after 5 days of therapeutic doses. Paediatr Anaesth 1999; 9: 463–5PubMedCrossRef
15.
go back to reference Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med 2002; 347: 1094–103PubMedCrossRef Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med 2002; 347: 1094–103PubMedCrossRef
16.
go back to reference Korpela R, Olkkola KT. Pharmacokinetics of intravenous diclofenac sodium in children. Eur J Clin Pharmacol 1990; 38: 293–5PubMedCrossRef Korpela R, Olkkola KT. Pharmacokinetics of intravenous diclofenac sodium in children. Eur J Clin Pharmacol 1990; 38: 293–5PubMedCrossRef
17.
go back to reference Nahata MC, Powell DA, Durrell DE, et al. Efficacy of ibuprofen in pediatric patients with fever. Int J Clin Pharmacol Ther Toxicol 1992; 30: 94–6PubMed Nahata MC, Powell DA, Durrell DE, et al. Efficacy of ibuprofen in pediatric patients with fever. Int J Clin Pharmacol Ther Toxicol 1992; 30: 94–6PubMed
18.
go back to reference Olkkola KT, Maunuksela EL. The pharmacokinetics of postoperative intravenous ketorolac tromethamine in children. Br J Clin Pharmacol 1991; 31: 182–4PubMedCrossRef Olkkola KT, Maunuksela EL. The pharmacokinetics of postoperative intravenous ketorolac tromethamine in children. Br J Clin Pharmacol 1991; 31: 182–4PubMedCrossRef
19.
go back to reference Kauffman RE, Nelson MV. Effect of age on ibuprofen pharmacokinetics and antipyretic response. J Pediatr 1992; 121: 969–73PubMedCrossRef Kauffman RE, Nelson MV. Effect of age on ibuprofen pharmacokinetics and antipyretic response. J Pediatr 1992; 121: 969–73PubMedCrossRef
20.
go back to reference Kokki H, Le Liboux A, Jekunen A, et al. Pharmacokinetics of ketoprofen syrup in small children. J Clin Pharmacol 2000; 40: 354–9PubMedCrossRef Kokki H, Le Liboux A, Jekunen A, et al. Pharmacokinetics of ketoprofen syrup in small children. J Clin Pharmacol 2000; 40: 354–9PubMedCrossRef
21.
go back to reference Anand K, Stevens B, McGrath P, editors. Pain in neonates. 2nd ed. Amsterdam: Elsevier, 2000 Anand K, Stevens B, McGrath P, editors. Pain in neonates. 2nd ed. Amsterdam: Elsevier, 2000
22.
go back to reference Romsing J, Walther-Larsen S. Peri-operative use of nonsteroidal anti-inflammatory drugs in children: analgesic efficacy and bleeding. Anaesthesia 1997; 52: 673–83PubMedCrossRef Romsing J, Walther-Larsen S. Peri-operative use of nonsteroidal anti-inflammatory drugs in children: analgesic efficacy and bleeding. Anaesthesia 1997; 52: 673–83PubMedCrossRef
24.
go back to reference Short JA, Barr CA, Palmer CD, et al. Use of diclofenac in children with asthma. Anaesthesia 2000; 55: 334–7PubMedCrossRef Short JA, Barr CA, Palmer CD, et al. Use of diclofenac in children with asthma. Anaesthesia 2000; 55: 334–7PubMedCrossRef
25.
go back to reference Kokki H, Hendolin H, Maunuksela EL, et al. Ibuprofen in the treatment of postoperative pain in small children: a randomized, double-blind, placebo-controlled parallel group study. Acta Anaesthesiol Scand 1994; 38: 467–72PubMedCrossRef Kokki H, Hendolin H, Maunuksela EL, et al. Ibuprofen in the treatment of postoperative pain in small children: a randomized, double-blind, placebo-controlled parallel group study. Acta Anaesthesiol Scand 1994; 38: 467–72PubMedCrossRef
26.
go back to reference Gadiyar V, Gallagher TM, Crean PM, et al. The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children. Anaesthesia 1995; 50: 820–2PubMedCrossRef Gadiyar V, Gallagher TM, Crean PM, et al. The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children. Anaesthesia 1995; 50: 820–2PubMedCrossRef
27.
go back to reference Mather LE. Do the pharmacodynamics of the nonsteroidal anti-inflammatory drugs suggest a role in the management of postoperative pain? Drugs 1992; 44: 1–13PubMedCrossRef Mather LE. Do the pharmacodynamics of the nonsteroidal anti-inflammatory drugs suggest a role in the management of postoperative pain? Drugs 1992; 44: 1–13PubMedCrossRef
28.
go back to reference Kokki H, Tuovinen K, Hendolin H. The effect of intravenous ketoprofen on postoperative epidural sufentanil analgesia in children. Anesth Analg 1999; 88: 1036–41PubMed Kokki H, Tuovinen K, Hendolin H. The effect of intravenous ketoprofen on postoperative epidural sufentanil analgesia in children. Anesth Analg 1999; 88: 1036–41PubMed
29.
go back to reference Kokki H, Nikanne E, Ahonen R. The feasibility of pain treatment at home after adenoidectomy with ketoprofen tablets in small children. Paediatr Anaesth 2000; 10: 531–5PubMedCrossRef Kokki H, Nikanne E, Ahonen R. The feasibility of pain treatment at home after adenoidectomy with ketoprofen tablets in small children. Paediatr Anaesth 2000; 10: 531–5PubMedCrossRef
30.
go back to reference Forrest JB, Heitlinger EL, Revell S. Ketorolac for postoperative pain management in children. Drug Saf 1997; 16: 309–29PubMedCrossRef Forrest JB, Heitlinger EL, Revell S. Ketorolac for postoperative pain management in children. Drug Saf 1997; 16: 309–29PubMedCrossRef
31.
go back to reference Teira HMO. PCA in paediatric orthopaedic patients: influence of a NSAID on morphine requirement. Paediatr Anaesth 1994; 4: 87–91CrossRef Teira HMO. PCA in paediatric orthopaedic patients: influence of a NSAID on morphine requirement. Paediatr Anaesth 1994; 4: 87–91CrossRef
32.
go back to reference Litalien C, Jacqz-Aigrain E. Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs 2001; 3: 817–58PubMedCrossRef Litalien C, Jacqz-Aigrain E. Risks and benefits of nonsteroidal anti-inflammatory drugs in children: a comparison with paracetamol. Paediatr Drugs 2001; 3: 817–58PubMedCrossRef
33.
go back to reference Farrar MW, Lerman J. Novel concepts for analgesia in pediatric surgical patients: cyclo-oxygenase-2 inhibitors, alpha 2-agonists, and opioids. Anesthesiol Clin North Am 2002; 20: 59–82CrossRef Farrar MW, Lerman J. Novel concepts for analgesia in pediatric surgical patients: cyclo-oxygenase-2 inhibitors, alpha 2-agonists, and opioids. Anesthesiol Clin North Am 2002; 20: 59–82CrossRef
34.
go back to reference Mikawa K, Nishina K, Maekawa N, et al. Oral clonidine premedication reduces postoperative pain in children. Anesth Analg 1996; 82: 225–30PubMed Mikawa K, Nishina K, Maekawa N, et al. Oral clonidine premedication reduces postoperative pain in children. Anesth Analg 1996; 82: 225–30PubMed
35.
go back to reference Moir MS, Bair E, Shinnick P, et al. Acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy. Laryngoscope 2000; 110: 1824–7PubMedCrossRef Moir MS, Bair E, Shinnick P, et al. Acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy. Laryngoscope 2000; 110: 1824–7PubMedCrossRef
36.
37.
go back to reference Goodarzi M. Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery. Paediatr Anaesth 1999; 9: 419–22PubMedCrossRef Goodarzi M. Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery. Paediatr Anaesth 1999; 9: 419–22PubMedCrossRef
38.
go back to reference Gall O, Aubineau JV, Berniere J, et al. Analgesic effect of low-dose intrathecal morphine after spinal fusion in children. Anesthesiology 2001; 94: 447–52PubMedCrossRef Gall O, Aubineau JV, Berniere J, et al. Analgesic effect of low-dose intrathecal morphine after spinal fusion in children. Anesthesiology 2001; 94: 447–52PubMedCrossRef
39.
go back to reference Kart T, Christrup LL, Rasmussen M. Recommended use of morphine in neonates, infants and children based on a literature review (part 1): pharmacokinetics. Paediatr Anaesth 1997; 7: 5–11PubMedCrossRef Kart T, Christrup LL, Rasmussen M. Recommended use of morphine in neonates, infants and children based on a literature review (part 1): pharmacokinetics. Paediatr Anaesth 1997; 7: 5–11PubMedCrossRef
40.
go back to reference Negri PD, Ivani G. Management of postoperative nausea and vomiting in children. Paediatr Drugs 2002; 4: 717–28PubMed Negri PD, Ivani G. Management of postoperative nausea and vomiting in children. Paediatr Drugs 2002; 4: 717–28PubMed
41.
go back to reference Beasley SW, Tibballs J. Efficacy and safety of continuous morphine infusion for postoperative analgesia in the paediatric surgical ward. Aust NZ J Surg 1987; 57: 233–7CrossRef Beasley SW, Tibballs J. Efficacy and safety of continuous morphine infusion for postoperative analgesia in the paediatric surgical ward. Aust NZ J Surg 1987; 57: 233–7CrossRef
42.
go back to reference Berde CB, Lehn BM, Yee JD, et al. Patient-controlled analgesia in children and adolescents: a randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia. J Pediatr 1991; 118: 460–6PubMedCrossRef Berde CB, Lehn BM, Yee JD, et al. Patient-controlled analgesia in children and adolescents: a randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia. J Pediatr 1991; 118: 460–6PubMedCrossRef
43.
go back to reference Doyle E, Harper I, Morton NS. Patient-controlled analgesia with low dose background infusions after lower abdominal surgery in children. Br J Anaesth 1993; 71: 818–22PubMedCrossRef Doyle E, Harper I, Morton NS. Patient-controlled analgesia with low dose background infusions after lower abdominal surgery in children. Br J Anaesth 1993; 71: 818–22PubMedCrossRef
44.
go back to reference Steinberg RB, Liu SS, Wu CL, et al. Comparison of ropivacaine-fentanyl patient-controlled epidural analgesia with morphine intravenous patient-controlled analgesia for perioperative analgesia and recovery after open colon surgery. J Clin Anesth 2002; 14: 571–7PubMedCrossRef Steinberg RB, Liu SS, Wu CL, et al. Comparison of ropivacaine-fentanyl patient-controlled epidural analgesia with morphine intravenous patient-controlled analgesia for perioperative analgesia and recovery after open colon surgery. J Clin Anesth 2002; 14: 571–7PubMedCrossRef
45.
go back to reference Krane EJ, Tyler DC, Jacobson LE. The dose response of caudal morphine in children. Anesthesiology 1989; 71: 48–52PubMedCrossRef Krane EJ, Tyler DC, Jacobson LE. The dose response of caudal morphine in children. Anesthesiology 1989; 71: 48–52PubMedCrossRef
46.
go back to reference Hesselgard K, Stromblad LG, Reinstrup P. Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children. Paediatr Anaesth 2001; 11: 75–9PubMedCrossRef Hesselgard K, Stromblad LG, Reinstrup P. Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children. Paediatr Anaesth 2001; 11: 75–9PubMedCrossRef
47.
go back to reference Wolf AR, Hughes D. Pain relief for infants undergoing abdominal surgery: comparison of infusions of iv morphine and extradural bupivacaine. Br J Anaesth 1993; 70: 10–6PubMedCrossRef Wolf AR, Hughes D. Pain relief for infants undergoing abdominal surgery: comparison of infusions of iv morphine and extradural bupivacaine. Br J Anaesth 1993; 70: 10–6PubMedCrossRef
48.
go back to reference Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr 1993; 122 (5 Pt 2): 14–20CrossRef Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr 1993; 122 (5 Pt 2): 14–20CrossRef
50.
go back to reference Wulf H, Peters C, Behnke H. The pharmacokinetics of caudal ropivacaine 0.2% in children: a study of infants aged less than 1 year and toddlers aged 1–5 years undergoing inguinal hernia repair. Anaesthesia 2000; 55: 757–60PubMedCrossRef Wulf H, Peters C, Behnke H. The pharmacokinetics of caudal ropivacaine 0.2% in children: a study of infants aged less than 1 year and toddlers aged 1–5 years undergoing inguinal hernia repair. Anaesthesia 2000; 55: 757–60PubMedCrossRef
51.
go back to reference Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg 1989; 68: 83–9PubMedCrossRef Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg 1989; 68: 83–9PubMedCrossRef
52.
go back to reference Breschan C, Schalk HV, Schaumberger F, et al. Experience with caudal blocks in children over a period of 3.5 years. Acta Anaesthesiol Scand Suppl 1996; 109: 174–6PubMed Breschan C, Schalk HV, Schaumberger F, et al. Experience with caudal blocks in children over a period of 3.5 years. Acta Anaesthesiol Scand Suppl 1996; 109: 174–6PubMed
53.
go back to reference Luz G, Innerhofer P, Haussler B, et al. Comparison of ropivacaine 0.1% and 0.2% with bupivacaine 0.2% for single-shot caudal anaesthesia in children. Paediatr Anaesth 2000; 10: 499–504PubMedCrossRef Luz G, Innerhofer P, Haussler B, et al. Comparison of ropivacaine 0.1% and 0.2% with bupivacaine 0.2% for single-shot caudal anaesthesia in children. Paediatr Anaesth 2000; 10: 499–504PubMedCrossRef
54.
go back to reference Cook B, Grubb DJ, Aldridge LA, et al. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia produced by bupivacaine in children. Br J Anaesth 1995; 75: 698–701PubMedCrossRef Cook B, Grubb DJ, Aldridge LA, et al. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia produced by bupivacaine in children. Br J Anaesth 1995; 75: 698–701PubMedCrossRef
55.
56.
go back to reference Markakis DA. Regional anesthesia in pediatrics. Anesthesiol Clin North Am 2000; 18: 355–81CrossRef Markakis DA. Regional anesthesia in pediatrics. Anesthesiol Clin North Am 2000; 18: 355–81CrossRef
57.
go back to reference Fell D, Derrington MC, Taylor E, et al. Paediatric postoperative analgesia: a comparison between caudal block and wound infiltration of local anaesthetic. Anaesthesia 1988; 43: 107–10PubMedCrossRef Fell D, Derrington MC, Taylor E, et al. Paediatric postoperative analgesia: a comparison between caudal block and wound infiltration of local anaesthetic. Anaesthesia 1988; 43: 107–10PubMedCrossRef
58.
go back to reference Shah R, Sabanathan S, Richardson J, et al. Continuous paravertebral block for post thoracotomy analgesia in children. J Cardiovasc Surg (Torino) 1997; 38: 543–6 Shah R, Sabanathan S, Richardson J, et al. Continuous paravertebral block for post thoracotomy analgesia in children. J Cardiovasc Surg (Torino) 1997; 38: 543–6
59.
go back to reference Andersen KH. A new method of analgesia for relief of circumcision pain. Anaesthesia 1989; 44: 118–20PubMedCrossRef Andersen KH. A new method of analgesia for relief of circumcision pain. Anaesthesia 1989; 44: 118–20PubMedCrossRef
60.
go back to reference Carden SM, Colville DJ, Davidson AJ, et al. Adjunctive intra-operative local anaesthesia in paediatric strabismus surgery: a randomized controlled trial. Aust NZ J Ophthalmol 1998; 26: 289–97CrossRef Carden SM, Colville DJ, Davidson AJ, et al. Adjunctive intra-operative local anaesthesia in paediatric strabismus surgery: a randomized controlled trial. Aust NZ J Ophthalmol 1998; 26: 289–97CrossRef
61.
go back to reference Kokki H, Ahonen R. Pain and activity disturbance after paediatric day case adenoidectomy. Paediatr Anaesth 1997; 7: 227–31PubMedCrossRef Kokki H, Ahonen R. Pain and activity disturbance after paediatric day case adenoidectomy. Paediatr Anaesth 1997; 7: 227–31PubMedCrossRef
62.
go back to reference Warnock FF, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain 1998; 75: 37–45PubMedCrossRef Warnock FF, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain 1998; 75: 37–45PubMedCrossRef
63.
go back to reference Romsing J, Hertel S, Harder A, et al. Examination of acetaminophen for outpatient management of postoperative pain in children. Paediatr Anaesth 1998; 8: 235–9PubMedCrossRef Romsing J, Hertel S, Harder A, et al. Examination of acetaminophen for outpatient management of postoperative pain in children. Paediatr Anaesth 1998; 8: 235–9PubMedCrossRef
64.
go back to reference Aouad MT, Siddik SS, Rizk LB, et al. The effect of dexamethasone on post-operative vomiting after tonsillectomy. Anesth Analg 2001; 92: 636–40PubMedCrossRef Aouad MT, Siddik SS, Rizk LB, et al. The effect of dexamethasone on post-operative vomiting after tonsillectomy. Anesth Analg 2001; 92: 636–40PubMedCrossRef
65.
go back to reference Tom LW, Templeton JJ, Thompson ME, et al. Dexamethasone in adenotonsillectomy. Int J Pediatr Otorhinolaryngol 1996; 37: 115–20PubMedCrossRef Tom LW, Templeton JJ, Thompson ME, et al. Dexamethasone in adenotonsillectomy. Int J Pediatr Otorhinolaryngol 1996; 37: 115–20PubMedCrossRef
66.
go back to reference Ohlms LA, Wilder RT, Weston B. Use of intraoperative corticosteroids in pediatric tonsillectomy. Arch Otolaryngol Head Neck Surg 1995; 121: 737–42PubMedCrossRef Ohlms LA, Wilder RT, Weston B. Use of intraoperative corticosteroids in pediatric tonsillectomy. Arch Otolaryngol Head Neck Surg 1995; 121: 737–42PubMedCrossRef
67.
go back to reference Hollis LJ, Burton MJ, Millar JM. Perioperative local anaesthesia for reducing pain following tonsillectomy. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Update Software, 2000 Hollis LJ, Burton MJ, Millar JM. Perioperative local anaesthesia for reducing pain following tonsillectomy. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Update Software, 2000
68.
go back to reference Finley GA, McGrath PJ, Forward SP, et al. Parents’ management of children’s pain following ‘minor’ surgery. Pain 1996; 64: 83–7PubMedCrossRef Finley GA, McGrath PJ, Forward SP, et al. Parents’ management of children’s pain following ‘minor’ surgery. Pain 1996; 64: 83–7PubMedCrossRef
69.
go back to reference Kokinsky E, Thornberg E, Ostlund AL, et al. Postoperative comfort in paediatric outpatient surgery. Paediatr Anaesth 1999; 9: 243–51PubMed Kokinsky E, Thornberg E, Ostlund AL, et al. Postoperative comfort in paediatric outpatient surgery. Paediatr Anaesth 1999; 9: 243–51PubMed
70.
go back to reference Irwin MG, Cheng W. Comparison of subcutaneous ring block of the penis with caudal epidural block for post-circumcision analgesia in children. Anaesth Intensive Care 1996; 24: 365–7PubMed Irwin MG, Cheng W. Comparison of subcutaneous ring block of the penis with caudal epidural block for post-circumcision analgesia in children. Anaesth Intensive Care 1996; 24: 365–7PubMed
71.
go back to reference Kokki H, Homan E, Tuovinen K, et al. Peroperative treatment with iv ketoprofen reduces pain and vomiting in children after strabismus surgery. Acta Anaesthesiol Scand 1999; 43: 13–8PubMedCrossRef Kokki H, Homan E, Tuovinen K, et al. Peroperative treatment with iv ketoprofen reduces pain and vomiting in children after strabismus surgery. Acta Anaesthesiol Scand 1999; 43: 13–8PubMedCrossRef
72.
go back to reference Morton NS, Benham SW, Lawson RA, et al. Diclofenac vs oxybuprocaine eyedrops for analgesia in paediatric strabismus surgery. Paediatr Anaesth 1997; 7: 221–6PubMedCrossRef Morton NS, Benham SW, Lawson RA, et al. Diclofenac vs oxybuprocaine eyedrops for analgesia in paediatric strabismus surgery. Paediatr Anaesth 1997; 7: 221–6PubMedCrossRef
73.
go back to reference Lambert AW, Mayor A. Analgesic requirements for appendicectomy: the differences between adults and children. Ann R Coll Surg Engl 2000; 82: 111–2PubMed Lambert AW, Mayor A. Analgesic requirements for appendicectomy: the differences between adults and children. Ann R Coll Surg Engl 2000; 82: 111–2PubMed
74.
go back to reference Lovstad RZ, Stoen R. Postoperative epidural analgesia in children after major orthopaedic surgery: a randomised study of the effect on PONV of two anaesthetic techniques: low and high dose iv fentanyl and epidural infusions with and without fentanyl. Acta Anaesthesiol Scand 2001; 45: 482–8PubMedCrossRef Lovstad RZ, Stoen R. Postoperative epidural analgesia in children after major orthopaedic surgery: a randomised study of the effect on PONV of two anaesthetic techniques: low and high dose iv fentanyl and epidural infusions with and without fentanyl. Acta Anaesthesiol Scand 2001; 45: 482–8PubMedCrossRef
Metadata
Title
Postoperative Pain Control in Children
A Guide to Drug Choice
Authors
Dr Eva Kokinsky
Eva Thornberg
Publication date
01-11-2003
Publisher
Springer International Publishing
Published in
Pediatric Drugs / Issue 11/2003
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI
https://doi.org/10.2165/00148581-200305110-00004

Other articles of this Issue 11/2003

Pediatric Drugs 11/2003 Go to the issue

Therapy In Practice

Neonatal Sepsis