Current Trends and New Strategies in Acute Postoperative Pain Management in Children

Main Article Content

Eduardo Vega Pérez Gonzalo Rivera Lizama Victor Gonzalez Cárdenas

Abstract

Acute postoperative pain in children is common. Nearly 40 percent of pediatric patients suffer from moderate to severe pain after surgery. Inadequate pain prevention and treatment has been associated with short and long-term consequences. Different treatment modalities have evolved lately, and multimodal analgesia has become the treatment of choice not only involving a pharmacological approach but also non-pharmacological approaches (eg, regional analgesia, rehabilitation, cognitive behavioral therapy, virtual reality). The aim of this article is to show current trends and strategies in the management of acute postoperative pain in children and how an inadequate treatment of it can lead to the development of chronic postsurgical pain. 

Keywords: Acute postoperative pain, children, pharmacological analgesia, regional anesthesia, chronic postsurgical pain, multimodal pain management

Article Details

How to Cite
PÉREZ, Eduardo Vega; LIZAMA, Gonzalo Rivera; CÁRDENAS, Victor Gonzalez. Current Trends and New Strategies in Acute Postoperative Pain Management in Children. Medical Research Archives, [S.l.], v. 9, n. 9, sep. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2539>. Date accessed: 24 dec. 2024. doi: https://doi.org/10.18103/mra.v9i9.2539.
Section
Research Articles

References

1. Walker SM. Pain after surgery in children: clinical recommendations. Curr Opin Anaesthesiol. Oct 2015;28(5):570-6. doi:10.1097/ACO.0000000000000227
2. Rabbitts JA, Groenewald CB, Zhou C. Subacute Pain Trajectories following major musculoskeletal surgery in adolescents: A Pilot Study. Can J Pain. 2020;4(4):3-12. doi:10.1080/24740527.2020.1765692
3. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg. Jul 2007;105(1):205-21. doi:10.1213/01.ane.0000268145.52345.55
4. Vittinghoff M, Lonnqvist PA, Mossetti V, et al. Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative). Paediatr Anaesth. Jun 2018;28(6):493-506. doi:10.1111/pan.13373
5. Verriotis M, Chang P, Fitzgerald M, Fabrizi L. The development of the nociceptive brain. Neuroscience. Dec 3 2016;338:207-219. doi:10.1016/j.neuroscience.2016.07.026
6. Mekonnen ZA, Melesse DY, Kassahun HG, Flatie TD, Workie MM, Chekol WB. Prevalence and Contributing Factors Associated With Postoperative Pain in Pediatric Patients: A Cross-Sectional Follow-up Study. Perioperative Care and Operating Room Management. 2021;23doi:10.1016/j.pcorm.2021.100159
7. Williams G, Howard RF, Liossi C. Persistent postsurgical pain in children and young people: prediction, prevention, and management. Pain Rep. Sep 2017;2(5):e616. doi:10.1097/PR9.0000000000000616
8. Chowdhury T, Garg R, Sheshadri V, et al. Perioperative Factors Contributing the Post-Craniotomy Pain: A Synthesis of Concepts. Front Med (Lausanne). 2017;4:23. doi:10.3389/fmed.2017.00023
9. Sieberg CB, Simons LE, Edelstein MR, et al. Pain prevalence and trajectories following pediatric spinal fusion surgery. J Pain. Dec 2013;14(12):1694-702. doi:10.1016/j.jpain.2013.09.005
10. Admassu WS, Hailekiros AG, Abdissa ZD. Severity and Risk Factors of Post-Operative Pain in University of Gondar Hospital, Northeast Ethiopa. Journal of Anesthesia & Clinical Research. 2016;7(10)doi:10.4172/2155-6148.1000675
11. Guay J, Suresh S, Kopp S. The Use of Ultrasound Guidance for Perioperative Neuraxial and Peripheral Nerve Blocks in Children: A Cochrane Review. Anesth Analg. Mar 2017;124(3):948-958. doi:10.1213/ANE.0000000000001363
12. Walker BJ, Long JB, Sathyamoorthy M, et al. Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network. Anesthesiology. Oct 2018;129(4):721-732. doi:10.1097/ALN.0000000000002372
13. Ecoffey C, Lacroix F, Giaufre E, Orliaguet G, Courreges P, Association des Anesthesistes Reanimateurs Pediatriques d'Expression F. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. Dec 2010;20(12):1061-9. doi:10.1111/j.1460-9592.2010.03448.x
14. Dadure C, Veyckemans F, Bringuier S, Habre W. Epidemiology of regional anesthesia in children: Lessons learned from the European Multi-Institutional Study APRICOT. Paediatr Anaesth. Nov 2019;29(11):1128-1135. doi:10.1111/pan.13741
15. Vargas A, Sawardekar A, Suresh S. Updates on pediatric regional anesthesia safety data. Curr Opin Anaesthesiol. Oct 2019;32(5):649-652. doi:10.1097/ACO.0000000000000768
16. Lonnqvist PA, Ecoffey C, Bosenberg A, Suresh S, Ivani G. The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia I and II: what do they tell us? Curr Opin Anaesthesiol. Oct 2017;30(5):613-620. doi:10.1097/ACO.0000000000000508
17. Tsui BC, Pillay JJ. Evidence-based medicine: Assessment of ultrasound imaging for regional anesthesia in infants, children, and adolescents. Reg Anesth Pain Med. Mar-Apr 2010;35(2 Suppl):S47-54. doi:10.1097/AAP.0b013e3181d32770
18. Pinto N, Sawardekar A, Suresh S. Regional Anesthesia: Options for the Pediatric Patient. Anesthesiol Clin. Sep 2020;38(3):559-575. doi:10.1016/j.anclin.2020.05.005
19. Walter CM, Abbasian N, Olbrecht VA. Trends in Pediatric Pain: Thinking Beyond Opioids. Anesthesiol Clin. Sep 2020;38(3):663-678. doi:10.1016/j.anclin.2020.04.002
20. Oksuz G, Bilal B, Gurkan Y, et al. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block in Children Undergoing Low Abdominal Surgery: A Randomized Controlled Trial. Reg Anesth Pain Med. Sep/Oct 2017;42(5):674-679. doi:10.1097/AAP.0000000000000645
21. Sato M. Ultrasound-guided quadratus lumborum block compared to caudal ropivacaine/morphine in children undergoing surgery for vesicoureteric reflex. Paediatr Anaesth. Jul 2019;29(7):738-743. doi:10.1111/pan.13650
22. Visoiu M, Pan S. Quadratus lumborum blocks: Two cases of associated hematoma. Paediatr Anaesth. Mar 2019;29(3):286-288. doi:10.1111/pan.13588
23. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. Sep-Oct 2016;41(5):621-7. doi:10.1097/AAP.0000000000000451
24. Tsui BCH, Fonseca A, Munshey F, McFadyen G, Caruso TJ. The erector spinae plane (ESP) block: A pooled review of 242 cases. J Clin Anesth. Mar 2019;53:29-34. doi:10.1016/j.jclinane.2018.09.036
25. Moore RP, Liu CJ, George P, et al. Early experiences with the use of continuous erector spinae plane blockade for the provision of perioperative analgesia for pediatric liver transplant recipients. Reg Anesth Pain Med. Apr 16 2019;doi:10.1136/rapm-2018-100253
26. Hernandez MA, Palazzi L, Lapalma J, Cravero J. Erector spinae plane block for inguinal hernia repair in preterm infants. Paediatr Anaesth. Mar 2018;28(3):298-299. doi:10.1111/pan.13325
27. Munoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anaesth. Aug 2017;64(8):880-882. doi:10.1007/s12630-017-0894-0
28. Naja ZM, Ziade FM, Kamel R, El-Kayali S, Daoud N, El-Rajab MA. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth Analg. Dec 2013;117(6):1401-7. doi:10.1213/ANE.0b013e3182a8ee52
29. Gaudet-Ferrand I, De La Arena P, Bringuier S, et al. Ultrasound-guided pudendal nerve block in children: A new technique of ultrasound-guided transperineal approach. Paediatr Anaesth. Jan 2018;28(1):53-58. doi:10.1111/pan.13286
30. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting- an updated report by the American Society of Anesthesiologists Task Force on. Anesthesiology. 2012 Feb;116(2):248-73. doi:doi: 10.1097/ALN.0b013e31823c1030. PMID: 22227789.
31. Tan M, Law LS, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth. Feb 2015;62(2):203-18. doi:10.1007/s12630-014-0275-x
32. Yaster M, Reid AL, Cohen MN, Monitto CL. Opioids in the Management of Acute Pediatric Pain: An Update in a Time of Crisis. Clin J Pain. Jun 2019;35(6):487-496. doi:10.1097/AJP.0000000000000709
33. Zhu A, Benzon HA, Anderson TA. Evidence for the Efficacy of Systemic Opioid-Sparing Analgesics in Pediatric Surgical Populations: A Systematic Review. Anesth Analg. Nov 2017;125(5):1569-1587. doi:10.1213/ANE.0000000000002434
34. Anderson BJ. Paracetamol (Acetaminophen): mechanisms of action. Paediatr Anaesth. Oct 2008;18(10):915-21. doi:10.1111/j.1460-9592.2008.02764.x
35. Wong I, St John-Green C, Walker SM. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Paediatr Anaesth. Jun 2013;23(6):475-95. doi:10.1111/pan.12163
36. Roberts CA, Shah-Becker S, O'Connell Ferster A, et al. Randomized Prospective Evaluation of Intraoperative Intravenous Acetaminophen in Pediatric Adenotonsillectomy. Otolaryngol Head Neck Surg. Feb 2018;158(2):368-374. doi:10.1177/0194599817728911
37. Rugyte D, Gudaityte J. Intravenous Paracetamol in Adjunct to Intravenous Ketoprofen for Postoperative Pain in Children Undergoing General Surgery: A Double-Blinded Randomized Study. Medicina (Kaunas). Apr 1 2019;55(4)doi:10.3390/medicina55040086
38. Olbrecht VA, Ding L, Spruance K, Hossain M, Sadhasivam S, Chidambaran V. Intravenous Acetaminophen Reduces Length of Stay Via Mediation of Postoperative Opioid Consumption After Posterior Spinal Fusion in a Pediatric Cohort. Clin J Pain. Jul 2018;34(7):593-599. doi:10.1097/AJP.0000000000000576
39. Michelet D, Andreu-Gallien J, Bensalah T, et al. A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Anesth Analg. Feb 2012;114(2):393-406. doi:10.1213/ANE.0b013e31823d0b45
40. Debono B, Wainwright TW, Wang MY, et al. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Spine J. May 2021;21(5):729-752. doi:10.1016/j.spinee.2021.01.001
41. Lewis SR, Nicholson A, Cardwell ME, Siviter G, Smith AF. Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev. Jul 18 2013;(7):CD003591. doi:10.1002/14651858.CD003591.pub3
42. Maroda AJ, Coca KK, McLevy-Bazzanella JD, Wood JW, Grissom EC, Sheyn AM. Perioperative Analgesia in Pediatric Patients Undergoing Otolaryngologic Surgery. Otolaryngol Clin North Am. Oct 2020;53(5):819-830. doi:10.1016/j.otc.2020.05.011
43. Maenchen N, Dam M, Sauter AR, et al. Reply to: importance of half-the-air pressure test in Shamrock lumbar plexus block. Eur J Anaesthesiol. Oct 2016;33(10):784-5. doi:10.1097/EJA.0000000000000466
44. Witschi L, Reist L, Stammschulte T, Erlenwein J, Becke K, Stamer U. Perioperative use of metamizole and other nonopioid analgesics in children: Results of a survey. Anaesthesist. Mar 2019;68(3):152-160. Perioperative Anwendung von Metamizol und anderen Nichtopioidanalgetika bei Kindern : Ergebnisse einer Umfrage. doi:10.1007/s00101-018-0532-4
45. de Leeuw TG, Dirckx M, Gonzalez Candel A, Scoones GP, Huygen F, de Wildt SN. The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review. Paediatr Anaesth. Dec 2017;27(12):1193-1201. doi:10.1111/pan.13257
46. Verret M, Lauzier F, Zarychanski R, et al. Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis. Anesthesiology. Aug 2020;133(2):265-279. doi:10.1097/ALN.0000000000003428
47. Lilius TO, Jokinen V, Neuvonen MS, Niemi M, Kalso EA, Rauhala PV. Ketamine coadministration attenuates morphine tolerance and leads to increased brain concentrations of both drugs in the rat. Br J Pharmacol. Jun 2015;172(11):2799-813. doi:10.1111/bph.12974
48. Subramaniam K, Subramaniam B, Steinbrook RA. Ketamine as adjuvant analgesic to opioids: a quantitative and qualitative systematic review. Anesth Analg. Aug 2004;99(2):482-95, table of contents. doi:10.1213/01.ANE.0000118109.12855.07
49. Dahmani S MD, Abback PS, Wood C, Brasher C, Nivoche Y, Mantz J. Ketamine for perioperative pain management in children- a meta-analysis of published studies. Paediatr Anaesth. 2011;21(6):636-52. doi:10.1111/j.1460-9592.2011.03566.x
50. Michelet D, Hilly J, Skhiri A, et al. Opioid-Sparing Effect of Ketamine in Children: A Meta-Analysis and Trial Sequential Analysis of Published Studies. Paediatr Drugs. Dec 2016;18(6):421-433. doi:10.1007/s40272-016-0196-y
51. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. Feb 2016;17(2):131-57. doi:10.1016/j.jpain.2015.12.008
52. Schwenk ES, Viscusi ER, Buvanendran A, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. Jul 2018;43(5):456-466. doi:10.1097/AAP.0000000000000806
53. Kaszynski M, Lewandowska D, Sawicki P, Wojcieszak P, Pagowska-Klimek I. Efficacy of intravenous lidocaine infusions for pain relief in children undergoing laparoscopic appendectomy: a randomized controlled trial. BMC Anesthesiol. Jan 5 2021;21(1):2. doi:10.1186/s12871-020-01218-0
54. El-Deeb A, El-Morsy GZ, Ghanem AAA, Elsharkawy AA, Elmetwally AS. The effects of intravenous lidocaine infusion on hospital stay after major abdominal pediatric surgery. A randomized double-blinded study. Egyptian Journal of Anaesthesia. 2019;29(3):225-230. doi:10.1016/j.egja.2013.02.005
55. Foo I, Macfarlane AJR, Srivastava D, et al. The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety. Anaesthesia. Feb 2021;76(2):238-250. doi:10.1111/anae.15270
56. Schnabel A, Reichl SU, Poepping DM, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta-analysis of randomized controlled trials. Paediatr Anaesth. Feb 2013;23(2):170-9. doi:10.1111/pan.12030
57. Bellon M, Le Bot A, Michelet D, et al. Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies. Pain Ther. Jun 2016;5(1):63-80. doi:10.1007/s40122-016-0045-2
58. Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H, collaborators* PWG. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. Jul 2021;76(7):947-961. doi:10.1111/anae.15299
59. Romantsik O, Calevo MG, Norman E, Bruschettini M. Clonidine for pain in non-ventilated infants. Cochrane Database Syst Rev. Apr 9 2020;4:CD013104. doi:10.1002/14651858.CD013104.pub2
60. Small C, Laycock H. Acute postoperative pain management. Br J Surg. Jan 2020;107(2):e70-e80. doi:10.1002/bjs.11477
61. Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review. JAMA Surg. Nov 1 2017;152(11):1066-1071. doi:10.1001/jamasurg.2017.0831
62. Gai N, Naser B, Hanley J, Peliowski A, Hayes J, Aoyama K. A practical guide to acute pain management in children. J Anesth. Jun 2020;34(3):421-433. doi:10.1007/s00540-020-02767-x
63. Lee CS, Merchant S, Chidambaran V. Postoperative Pain Management in Pediatric Spinal Fusion Surgery for Idiopathic Scoliosis. Paediatr Drugs. Dec 2020;22(6):575-601. doi:10.1007/s40272-020-00423-1
64. Fortenberry M, Crowder J, So TY. The Use of Codeine and Tramadol in the Pediatric Population-What is the Verdict Now? J Pediatr Health Care. Jan 2019;33(1):117-123. doi:10.1016/j.pedhc.2018.04.016
65. Ding L, Hua H, Zhu H, et al. Effects of virtual reality on relieving postoperative pain in surgical patients: A systematic review and meta-analysis. Int J Surg. Oct 2020;82:87-94. doi:10.1016/j.ijsu.2020.08.033
66. Eijlers R, Utens E, Staals LM, et al. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth Analg. Nov 2019;129(5):1344-1353. doi:10.1213/ANE.0000000000004165
67. Schug SA, Lavand'homme P, Barke A, et al. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. Jan 2019;160(1):45-52. doi:10.1097/j.pain.0000000000001413
68. Steyaert A, Lavand'homme P. Prevention and Treatment of Chronic Postsurgical Pain: A Narrative Review. Drugs. Mar 2018;78(3):339-354. doi:10.1007/s40265-018-0866-x
69. Schug SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. Nov 2017;2(6):e627. doi:10.1097/PR9.0000000000000627
70. Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM. Prevalence and Predictors of Chronic Postsurgical Pain in Children: A Systematic Review and Meta-Analysis. J Pain. Jun 2017;18(6):605-614. doi:10.1016/j.jpain.2017.03.007
71. Page MG, Stinson J, Campbell F, Isaac L, Katz J. Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain. J Pain Res. 2013;6:167-80. doi:10.2147/JPR.S40846
72. Connelly M, Fulmer RD, Prohaska J, et al. Predictors of postoperative pain trajectories in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). Feb 1 2014;39(3):E174-81. doi:10.1097/BRS.0000000000000099
73. Sleed M, Eccleston C, Beecham J, Knapp M, Jordan A. The economic impact of chronic pain in adolescence: methodological considerations and a preliminary costs-of-illness study. Pain. Dec 15 2005;119(1-3):183-190. doi:10.1016/j.pain.2005.09.028
74. Pogatzki-Zahn EM, Segelcke D, Schug SA. Postoperative pain-from mechanisms to treatment. Pain Rep. Mar 2017;2(2):e588. doi:10.1097/PR9.0000000000000588
75. Batoz H, Semjen F, Bordes-Demolis M, Benard A, Nouette-Gaulain K. Chronic postsurgical pain in children: prevalence and risk factors. A prospective observational study. Br J Anaesth. Oct 2016;117(4):489-496. doi:10.1093/bja/aew260
76. Rabbitts JA, Palermo TM, Lang EA. A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents. J Pain Res. 2020;13:3071-3080. doi:10.2147/JPR.S239320
77. Ferland CE, Vega E, Ingelmo PM. Acute pain management in children: challenges and recent improvements. Curr Opin Anaesthesiol. Jun 2018;31(3):327-332. doi:10.1097/ACO.0000000000000579
78. Braun M, Bello C, Riva T, et al. Quantitative Sensory Testing to Predict Postoperative Pain. Curr Pain Headache Rep. Jan 14 2021;25(1):3. doi:10.1007/s11916-020-00920-5
79. Carley ME, Chaparro LE, Choiniere M, et al. Pharmacotherapy for the Prevention of Chronic Pain after Surgery in Adults: An Updated Systematic Review and Meta-analysis. Anesthesiology. Aug 1 2021;135(2):304-325. doi:10.1097/ALN.0000000000003837
80. Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev. Jul 24 2013;(7):CD008307. doi:10.1002/14651858.CD008307.pub2
81. Schug SA PP. Does perioperative ketamine have a role in the prevention of chronic postsurgical pain- the ROCKet trial. Br J Pain. 2017;11:166-168.
82. Bailey M, Corcoran T, Schug S, Toner A. Perioperative lidocaine infusions for the prevention of chronic postsurgical pain: a systematic review and meta-analysis of efficacy and safety. Pain. Sep 2018;159(9):1696-1704. doi:10.1097/j.pain.0000000000001273
83. Nicholls JL, Azam MA, Burns LC, et al. Psychological treatments for the management of postsurgical pain: a systematic review of randomized controlled trials. Patient Relat Outcome Meas. 2018;9:49-64. doi:10.2147/PROM.S121251
84. McNicol ED, Schumann R, Haroutounian S. A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain. Acta Anaesthesiol Scand. Nov 2014;58(10):1199-213. doi:10.1111/aas.12377