Department of Anaesthesiology and Intensive Therapy for Kids, Provincial Polyclinical Hospital in Toruń, Poland.
Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wrocław, Poland.
Anaesthesiol Intensive Ther. 2022;54(3):197-218. doi: 10.5114/ait.2022.118972.
RATIONALE AND SCOPE OF THE GUIDELINES Pain is a subjective unpleasant sensory and emotional experience. Acute pain occurs irrespective of age and has a prevalence of about 5% of the general population. Surgical procedures and painful diagnostic procedures are the main causes of this unpleasant and dangerous phenomenon for hospitalized children. It should be remembered that maintaining homeostasis in a child undergoing surgery is also affected by provision of an adequate level of analgesia and sedation as well as nerve conduction block within the surgical site. Even though both paediatric anaesthesiologists and paediatric surgeons know that the therapeutic activities during the perioperative period should be focused on ensuring sufficient analgesia and haemodynamic stability in surgical patients, as many as 70% of children undergoing surgery may experience moderate to severe pain [1-7]. Moreover, pain management is one of the fundamental human rights, i.e. the right to relief of suffering. According to the declaration of the 13th World Congress on Pain in Montreal (September 2010), this right also includes children [8, 9]. In Poland, the law was amended in 2017, and now each patient is guaranteed the right to relief and treatment of pain (Journal of Laws of 2017, item 836). Unfortunately, this right is not always respected in paediatric patients. Many factors contribute to ineffective analgesia in paediatric patients, mainly insufficient knowledge and lack of experience (concerning the use of opioids in particular), as well as lack of management standards, the negative attitude of the personnel or poor organization [10-13]. In hospitals which, as a result of organizational changes, have implemented analgesic treatment regimens and regularly educate their personnel in these issues, both efficiency and effectiveness of pain relief in children are high [14]. For many years, Polish paediatric anaesthesio-logists have been promoting and streamlining the analgesic management of children, which has led to the development of the present publication. The regimens presented in it are based on both the latest medical reports and many years of the authors' experience. The classes of recommendations and levels of evidence have been prepared (Tables 1 and 2, respectively). The presented recommendations were formulated based on a survey of medical reports published in the last two decades.
背景和范围 疼痛是一种主观的不愉快的感觉和情感体验。急性疼痛发生与年龄无关，其在普通人群中的患病率约为 5%。手术过程和有疼痛的诊断程序是导致住院儿童出现这种不愉快和危险现象的主要原因。应当记住，在接受手术的儿童中维持内环境平衡也受到提供足够水平的镇痛和镇静以及手术部位的神经传导阻滞的影响。尽管儿科麻醉师和小儿外科医生都知道围手术期的治疗活动应侧重于确保手术患者有足够的镇痛和血液动力学稳定性，但多达 70%接受手术的儿童可能会经历中度至重度疼痛[1-7]。此外，疼痛管理是基本人权之一，即减轻痛苦的权利。根据在蒙特利尔举行的第 13 届世界疼痛大会（2010 年 9 月）的宣言，这一权利还包括儿童[8,9]。在波兰，法律于 2017 年进行了修订，现在每个患者都保证有缓解和治疗疼痛的权利（2017 年法律杂志，第 836 项）。不幸的是，在儿科患者中，这一权利并不总是得到尊重。许多因素导致儿科患者的镇痛效果不佳，主要是知识不足和缺乏经验（特别是关于阿片类药物的使用），以及缺乏管理标准、人员的消极态度或组织不善[10-13]。在由于组织变革而实施镇痛治疗方案并定期对人员进行这些问题培训的医院中，儿童的疼痛缓解效率和效果都很高[14]。多年来，波兰儿科麻醉师一直在促进和简化儿童的镇痛管理，这导致了本出版物的发展。其中介绍的方案基于最新的医学报告和作者多年的经验。已经准备了建议的类别和证据水平（分别为表 1 和表 2）。提出的建议是基于对过去二十年发表的医学报告的调查制定的。
