Rieder Michael J, Jong Geert 't
Canadian Paediatric Society, Drug Therapy and Hazardous Substances Committee, Ottawa, Ontario.
Paediatr Child Health. 2021 Mar 16;26(2):120-127. doi: 10.1093/pch/pxaa133. eCollection 2021 Apr-May.
Pain is a common problem for children, and pain management comprises both pharmacologic and nonpharmacologic measures. For moderate to severe pain, oral opioids have been a popular choice for the last few decades. Codeine has historically been the best-known oral opioid for use in children. However, availability and use of codeine have sharply declined due to safety concerns. A variety of other opioids have been used in place of codeine, but data are limited regarding their efficacy and safety in children. While the same pathways metabolize oral oxycodone as codeine, oxycodone's pharmacokinetics varies widely. There are also limited data on the safety and efficacy of oral hydromorphone and tramadol use for children. Oral morphine is the opiate alternative to codeine for which there is the most evidence of safety and efficacy in children. Research is needed to investigate both other opioids and non-opioid approaches to guide evidence-based analgesic therapy and treatment for moderate-to-severe pain in children.
疼痛是儿童常见的问题，疼痛管理包括药物和非药物措施。在过去几十年里，对于中度至重度疼痛，口服阿片类药物一直是常用选择。可待因一直是历史上最知名的用于儿童的口服阿片类药物。然而，由于安全问题，可待因的可得性和使用量已大幅下降。已使用多种其他阿片类药物替代可待因，但关于它们在儿童中的疗效和安全性的数据有限。虽然口服羟考酮与可待因通过相同的途径代谢，但其药代动力学差异很大。关于儿童使用口服氢吗啡酮和曲马多的安全性和疗效的数据也有限。口服吗啡是可待因的阿片类替代药物，有最多证据表明其在儿童中安全有效。需要开展研究以调查其他阿片类药物和非阿片类方法，从而为儿童中度至重度疼痛的循证镇痛治疗提供指导。
