Paediatric analgesia : which drug ? which dose ?

The pharmacological management of paediatric pain is an area which is undergoing considerable development. Improvements in pain management are coming from appreciation of the special problems of children, increased knowledge of drug pharmacology and the development of better methods of drug delivery. Traditional methods of postoperative analgesia such as intramuscular injections are disliked by children and are being replaced by intravenous infusions, patient-controlled analgesia (PCA) and epidural opioids. Local anaesthetic blocks offer the benefit of fewer side effects and for certain procedures can provide complete pain relief in the immediate postoperative period. Inhaled analgesics such as nitrous oxide can be adapted for use in children and provide excellent analgesia for short painful procedures. The pain from needles is reduced considerably by the use of local anaesthetic creams. There has been greater appreciation of the benefits of drug combination, particularly with cancer pain management, and the importance of providing long term analgesia for these patients and patients with burns. Considerable scope exists for future developments such as transmucosal and transdermal drug delivery systems and other methods of drug delivery which are suited to the special needs of children.