Mishra Priyanka, Tomar Anupama, Kumar Ajit, Nath Amborish, Sharma Suresh K, Singh Girish Kumar
Department of Anesthesiology and Critical Care, AIIMS, Rishikesh, India.
Department of Burns and Plastic Surgery, AIIMS, Rishikesh, India.
Saudi J Anaesth. 2021 Jan-Mar;15(1):33-39. doi: 10.4103/sja.SJA_635_20. Epub 2021 Jan 5.
Despite our growing knowledge about the COVID pandemic, not much concern has been focused upon the effective pain management in pediatric patients suffering from this SARS CoV2 virus. Symptoms with pain like myalgia (10%-40%), sore throat (5%-30%), headache (14%-40%) and abdominal pain (10%) are common in children suffering from COVID. (3-5) We conducted a systematic review regarding analgesia for COVID positive pediatric patients. Cochrane, PubMed, and Google scholar databases were searched for relevant literature. Owing to the novel status of COVID-19 with limited literature, we included randomized controlled trials (RCTs), observational studies, case series and case reports in the descending order of consideration. Articles in languages other than English, abstract only articles and non-scientific commentaries were excluded. The Primary outcome was evaluation of pain related symptoms and best strategies for their management. Our review revealed that a multidisciplinary approach starting from non-pharmacological techniques like drinking plenty of water, removing triggers like inadequate sleep, specific foods and psychotherapy including distraction, comfort and cognitive behavioural strategies should be used. Pharmacological approaches like acetaminophen, NSAIDS, spasmolytics etc. can be used if non-pharmacological therapy is inadequate. As per the current strength of evidence, acetaminophen and ibuprofen can be safely administered for pain management in children with COVID-19. Undertreated pain is a significant contributor to increased morbidity and poor prognosis. Integration of evidence based non-pharmacotherapies in the multidisciplinary pain management will contribute towards improved functioning, early recovery and better quality care for pediatric patients suffering from COVID.
尽管我们对新冠疫情的了解日益增加，但对于感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的儿科患者的有效疼痛管理，却没有得到太多关注。感染新冠的儿童常见疼痛症状，如肌痛（10%-40%）、咽痛（5%-30%）、头痛（14%-40%）和腹痛（10%）。（3-5）我们对新冠阳性儿科患者的镇痛进行了系统评价。检索了Cochrane、PubMed和谷歌学术数据库中的相关文献。由于新冠疫情的新颖性，相关文献有限，我们按照优先考虑顺序纳入了随机对照试验（RCT）、观察性研究、病例系列和病例报告。排除非英文文章、仅摘要文章和非科学评论。主要结局是评估疼痛相关症状及其最佳管理策略。我们的评价显示，应采用多学科方法，从非药物技术开始，如多喝水、消除睡眠不足、特定食物等诱因，以及包括分散注意力、安慰和认知行为策略在内的心理治疗。如果非药物治疗不足，可以使用对乙酰氨基酚、非甾体抗炎药、解痉药等药物治疗方法。根据目前的证据强度，对乙酰氨基酚和布洛芬可安全用于新冠-19患儿的疼痛管理。疼痛治疗不足是发病率增加和预后不良的重要因素。将循证非药物疗法纳入多学科疼痛管理，将有助于改善新冠患儿的功能、促进早期康复并提供更高质量的护理。
