One of the aims of anaesthesia is to allow pain-free surgical conditions, not only peroperatively, but also, more importantly, postoperatively for patients. All surgical patients should benefit from adequate pain management and this includes paediatric patients. For years the need to achieve postoperative pain-free conditions has been underestimated and even ignored in children. Various factors may have accounted for this situation. Firstly, neonates possess an immature myelinization of the nervous system. This may alter the behavioural response to pain. It is, however, unjustified to assume that paediatric patients feel less pain than adults, or that the response to acute surgical pain is different. Secondly, incomplete skeletal ossification may influence the pharmacodynamics/ pharmacokinetics of local anaesthetics. This may lead to a greater risk of the side effects of analgesics and/or local anaesthetics. Skilfully performed nerve blocks, the administration of clinical doses of analgesics rather than maximum doses and adequate monitoring of patients are all useful in reducing postoperative pain and the side effects of analgesic drugs. Continuing education and practical training of residents in anaesthesia and of personnel from the recovery room and the ward will also reduce the risk of neurological injury and may even avoid side effects. Thirdly, there is no reliable method of assessing pain, especially in paediatric patients.
展开▼
