Pounder D R, Steward D J
Department of Anaesthesia, British Columbia's Children's Hospital, Vancouver.
Can J Anaesth. 1992 Nov;39(9):969-74. doi: 10.1007/BF03008348.
The purpose of this review is to emphasise the ineffectiveness of traditional analgesic therapy in paediatric patients after surgery, to examine the sensation of pain in infants and children, and to describe the use of intravenous opioids for postoperative analgesia. The management of acute postoperative pain in the paediatric surgical population has been poor. This is despite the knowledge that infants and children have sufficient neurological development at birth to sense pain, and that the same hormonal and metabolic responses to nociceptive stimuli that occur in adult also occur in the neonate. Physicians frequently order analgesics in inappropriate doses, nurses are reluctant to administer opioids, and children themselves frequently compound the problem by refusing injections. The sophisticated techniques for providing postoperative analgesia which have been used so successfully in adults can also be used in paediatric patients. Two of these, continuous intravenous opioid infusion and patient-controlled analgesia, have proved to be very successful. Children older than six months can receive either modality safely with regular monitoring by qualified nursing staff. Infants younger than six months receiving continuous opioid infusions should be monitored in high-dependency units.
本综述的目的是强调传统镇痛疗法在儿科患者术后的无效性，探讨婴幼儿和儿童的疼痛感受，并描述静脉注射阿片类药物在术后镇痛中的应用。儿科手术人群急性术后疼痛的管理一直很差。尽管已知婴幼儿出生时神经发育足以感知疼痛，并且新生儿对伤害性刺激的激素和代谢反应与成人相同，但情况依然如此。医生经常开出剂量不当的镇痛药，护士不愿使用阿片类药物，而儿童自身也常常因拒绝注射而使问题复杂化。在成人中已成功使用的复杂术后镇痛技术也可用于儿科患者。其中两种，即持续静脉注射阿片类药物和患者自控镇痛，已被证明非常成功。六个月以上的儿童在合格护理人员的定期监测下可以安全地接受这两种方式中的任何一种。接受持续阿片类药物输注的六个月以下婴儿应在高依赖病房进行监测。
