Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland.
Clin Pharmacol Ther. 2019 May;105(5):1130-1138. doi: 10.1002/cpt.1358. Epub 2019 Mar 1.
Acute nociceptive pain management in children is a major public health concern. Effective and safe pain treatment is essential, but safety data cannot be simply extrapolated from adults to children due to pharmacokinetic and pharmacodynamic specificities. In addition, the frequent absence of child-specific data, the difficulty to assess drug tolerability, and the infants' inability to communicate properly and voluntarily report adverse drug reactions make children more vulnerable to safety issues. Awareness of the possible toxicity of analgesics is important but should not lead to suboptimal dosing and underuse of analgesia. A better assessment and individualization of treatment should allow effective prescribing of analgesics in more secure conditions. This article aims to review the safety of acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids in children and the precautions that should be taken.
儿童急性疼痛管理是一个重大的公共卫生关注点。有效的和安全的疼痛治疗是至关重要的，但是由于药代动力学和药效学的特殊性，安全性数据不能简单地从成年人外推到儿童。此外，由于缺乏儿童特异性数据、难以评估药物耐受性以及婴儿无法正确、自愿地报告药物不良反应，儿童更容易出现安全问题。认识到镇痛药可能的毒性很重要，但不应导致剂量不足和镇痛不足。更好的评估和个体化治疗应该允许更安全地开具镇痛药。本文旨在回顾在儿童中使用对乙酰氨基酚、非甾体抗炎药和阿片类药物的安全性以及应采取的注意事项。
