Ferland Catherine E, Vega Eduardo, Ingelmo Pablo M
Department of Anesthesia, McGill University.
Chronic Pain Service, Montreal Children's Hospital.
Curr Opin Anaesthesiol. 2018 Jun;31(3):327-332. doi: 10.1097/ACO.0000000000000579.
The evidence regarding the efficacy of analgesics available to guide postoperative pain treatment in pediatric patients is limited. Opioid medications are very often an important component of pediatric postoperative pain treatment but have been associated with perioperative complications. We will focus on initiatives aiming to provide effective treatment minimizing the use of opioids and preventing the long-term consequences of pain.
Interpatient variability in postoperative pain is currently managed by applying protocols or by trial and error, thus often leading to patients being either undertreated or overtreated. Few evidence-based reports are available to guide the use of opioid medications in children, including the prescription of opioids after hospital discharge. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids, thus decreasing the risk of toxicity and dose-related side effects. There is a lack of adequate research in this field, and more specifically on identifying which patient is at higher risk of poor postoperative pain management.
Treatment options have evolved in recent years, including the combinations of multimodal regimens and regional anesthetic techniques. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids.
关于可用于指导儿科患者术后疼痛治疗的镇痛药疗效的证据有限。阿片类药物常常是儿科术后疼痛治疗的重要组成部分，但与围手术期并发症相关。我们将重点关注旨在提供有效治疗、尽量减少阿片类药物使用并预防疼痛长期后果的举措。
目前通过应用方案或反复试验来处理术后疼痛的个体间差异，因此常常导致患者治疗不足或过度治疗。几乎没有基于证据的报告可指导儿童阿片类药物的使用，包括出院后阿片类药物的处方。采用多模式方法联合使用非阿片类镇痛药可能会减少对阿片类药物的需求，从而降低毒性风险和剂量相关副作用。该领域缺乏充分的研究，更具体地说，缺乏关于确定哪些患者术后疼痛管理不善风险较高的研究。
近年来治疗选择有所发展，包括多模式方案和区域麻醉技术的联合应用。采用多模式方法联合使用非阿片类镇痛药可能会减少对阿片类药物的需求。
