Department of Anaesthesiology, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
Eur J Anaesthesiol. 2010 Oct;27(10):851-7. doi: 10.1097/EJA.0b013e328338c4af.
Acute and chronic pain management in children is increasingly characterized by either a multimodal or a preventive analgesia approach, in which smaller doses of opioid and nonopioid analgesics, such as nonsteroidal anti-inflammatory drugs, local anaesthetics, N-methyl-D-aspartate antagonists, alpha(2)-adrenergic agonists, and voltage-gated calcium channel alpha-2 delta-proteins, are combined alone and in combination with opioids to maximize pain control and minimize drug-induced adverse side effects. A multimodal approach uses nonpharmacological complementary and alternative medicine therapies too. These include distraction, guided imagery, hypnosis, relaxation techniques, biofeedback, transcutaneous electrical nerve stimulation, and acupuncture. Using the neurophysiology of pain as a blueprint, the molecular targets and strategies used in multimodal pain management are described. Finally, weight-based dosage guidelines for commonly used opioid and nonopioid analgesics are provided to facilitate therapy.
儿童的急性和慢性疼痛管理越来越多地采用多模式或预防性镇痛方法，其中较小剂量的阿片类药物和非阿片类药物镇痛剂，如非甾体抗炎药、局部麻醉剂、N-甲基-D-天冬氨酸拮抗剂、α(2)-肾上腺素能激动剂和电压门控钙通道α-2δ-蛋白，单独和与阿片类药物联合使用，以最大程度地控制疼痛并最小化药物引起的不良反应。多模式方法还使用非药物性的补充和替代医学疗法。这些方法包括分散注意力、引导想象、催眠、放松技术、生物反馈、经皮电神经刺激和针灸。根据疼痛的神经生理学作为蓝图，描述了多模式疼痛管理中使用的分子靶点和策略。最后，提供了常用阿片类药物和非阿片类药物镇痛剂的基于体重的剂量指南，以促进治疗。
