Bhatt-Mehta V, Rosen D A
College of Pharmacy, Neonatal Intensive Care Unit, University of Michigan Medical Center, Ann Arbor.
Clin Pharm. 1991 Sep;10(9):667-85.
The pathophysiology, assessment, and pharmacologic management of acute pain in infants and children are reviewed, and the mechanism of action, pharmacokinetics, clinical efficacy, adverse effects, and dosages of opioid analgesics, nonopioid analgesics, and local anesthetics used for regional blocks are discussed. The pathophysiology of pain and the physiologic rationale for treatment of pain are similar in children and adults. Severe pain can be controlled by i.v. or epidural administration of opioid analgesics. Neonates are more susceptible to the depressant effects of opioids, and opioid analgesia must be administered with caution in infants who are not receiving mechanical ventilation because of the associated risk of respiratory depression. Patient-controlled analgesia is a useful technique in older children. Acetaminophen and NSAIDs are useful for relieving milder pain of noninflammatory and inflammatory origin, respectively. Epidural or intrathecal administration of local anesthetics provides regional analgesia with minimal physiologic alterations. Topical application of local anesthetics is effective for many minor procedures. A variety of pain management techniques are available for the management of acute pain in pediatric patients. The development of drugs having fewer adverse effects and noninvasive administration techniques will be important research priorities in the coming years.
本文综述了婴幼儿和儿童急性疼痛的病理生理学、评估及药物治疗，并讨论了用于区域阻滞的阿片类镇痛药、非阿片类镇痛药和局部麻醉药的作用机制、药代动力学、临床疗效、不良反应及剂量。儿童和成人疼痛的病理生理学及疼痛治疗的生理原理相似。严重疼痛可通过静脉注射或硬膜外给予阿片类镇痛药来控制。新生儿对阿片类药物的抑制作用更敏感，对于未接受机械通气的婴儿，由于存在呼吸抑制相关风险，必须谨慎使用阿片类镇痛药。患者自控镇痛是大龄儿童有用的技术。对乙酰氨基酚和非甾体抗炎药分别可有效缓解非炎性和炎性来源的轻度疼痛。硬膜外或鞘内注射局部麻醉药可提供区域镇痛，且生理改变最小。局部麻醉药的局部应用对许多小手术有效。有多种疼痛管理技术可用于小儿患者急性疼痛的管理。开发不良反应更少的药物和非侵入性给药技术将是未来几年重要的研究重点。
