Tamura Takako
Department of Anesthesia and Clitical Care, National Center for Child Health and Development, Tokyo 157-8535.
Masui. 2013 Sep;62(9):1080-7.
The practice of pediatric pain management has made a great progress in the last decade with the development and validation of pain assessment tools specific to pediatric patients. Adequate pediatric pain management has not been advanced as that of adult analgesia due to a lack of clinical knowledge, insufficient pediatric research and the fear of opioid side effects and addiction. Even pediatric anesthesiologists have believed the myths that neonates and infants do not feel severe pain compared to adults because of immatured development of nervous system. The recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma advanced in pediatric pain management. Accurate assessment of pain in different age groups and the effective treatment of postoperative pain are constantly being refined. Systemic opioids in patient-controlled analgesia, nonsteroidal antiinflammatory agents and regional analgesics alone or combined with additives are currently used to provide effective postoperative analgesia. These modalities are best utilized when combined in a multimodal approach to treat acute pain in perioperative pediatric patients.
在过去十年中，随着针对儿科患者的疼痛评估工具的开发和验证，儿科疼痛管理实践取得了巨大进展。由于临床知识不足、儿科研究不够充分以及对阿片类药物副作用和成瘾的担忧，充分的儿科疼痛管理尚未像成人镇痛那样得到发展。甚至儿科麻醉医生也相信一些错误观念，即由于神经系统发育不成熟，新生儿和婴儿与成人相比不会感到剧烈疼痛。认识到未治疗的疼痛是手术创伤后发病甚至死亡的重要原因，这推动了儿科疼痛管理的发展。对不同年龄组疼痛的准确评估以及术后疼痛的有效治疗也在不断完善。目前，患者自控镇痛中的全身性阿片类药物、非甾体类抗炎药和局部镇痛药单独使用或与添加剂联合使用，以提供有效的术后镇痛。当以多模式方法联合使用这些方式来治疗围手术期儿科患者的急性疼痛时，效果最佳。
