Postoperative analgesia : opioid infusions in infants and children

The purpose of this review is to emphasise the ineffectiveness of traditional analgesic therapy in paediatric patients after surgery, to examine the sensation of pain in infants and children, and to describe the use of intravenous opioids for postoperative analgesia. The management of acute postoperative pain in the paediatric surgical population has been poor. This is despite the knowledge that infants and children have sufficient neurological development at birth to sense pain, and that the same hormonal and metabolic responses to nociceptive stimuli that occur in adult also occur in the neonate. Physicians frequently order analgesics in inappropriate doses, nurses are reluctant to administer opioids, and children themselves frequently compound the problem by refusing injections. The sophisticated techniques for providing postoperative analgesia which have been used so successfully in adults can also be used in paediatric patients. Two of these, continuous intravenous opioid infusion and patient-controlled analgesia, have proved to be very successful. Children older than six months can receive either modality safely with regular monitoring by qualified nursing staff. Infants younger than six months receiving continuous opioid infusions should be monitored in high-dependency units.