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Pain Response
Premature infants show metabolic stress
responses postoperatively that can be
blocked by intravenous opioids.
The increasing crying and behavioural
changes occur for days after circumcision
can be blocked with the use of regional
anesthesia.
Inadequate Pediatric Pain Management
regardless of age
Fishman SM. Recognizing Pain Management as a Human Right: A First Step
Anesthesia Analgesia 2007.
Pediatric Pain Assessment
Pain management begins with an assessment of
the child with pain .
Not only the explicit pain features but also the
situational factors that modulate pain-measurement of
infant pain is just one aspect of comprehensive pain
assessment.
Pain in infants can only be accessed & measured by
indirect method.
Unidimensional tool
Multidimensional tool
Crying characteristics.
Facial expressions. More specific and
Simple motor responses. consistent than
physiological
Complex behavioural measurements.
responses.
Physiological Parameters
Heart rate.
Respiratory rate.
Blood pressure.
Palmar sweating. Objective,
Vagal tone. Precise , but
not specific for pain
Oxygen saturation.
Transcutaneous O2/CO2.
Intracranial pressure.
Biochemical Parameters
NASO-
LABIAL FOLD
deepened
Cry Spectrography
Crying hunger,anger,discomfort ,pain ?
ABC Pain Analyzer :
* Is the first cry acute ?
* Are burst rhythmic ?
* Is crying constant in time ?
Ketoprofen 2 1 6-8 5
Ibuprofen 10 10 6-8 40
Naproxen 10 5 8-12 15
Diclofenac 2 1 6-8 3
Ketorolac 0.5 0.25 6-8 2
Vd t1/2 CL
(L/kg) (h) (ml/min/kg)
Preterm 2.8 + 2.6 9.0 + 3.4 2.2 + 0.7
Kart T, Lona L. Recommended Use of Morphine in Neonates,Infants and Children Based on Literature
Review : Part 1 – Pharmacokinetics.
Pediatric Anesthesia 1997.
Caudal epidural analgesia
Most popular central block
Easiest & safest approach
Excellent analgesia-painfree awakening
Applicable to children of all ages