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Chapter 44. Acute and Chronic Pain Management in Children

Which of the following statements is true regarding neonatal pain infrastructure?

A. The sensation for pain is not present.

B. Significant pain structures exist as early as the second trimester.

C. Hydromorphone is not an effective drug for immature receptors.

D. Newborn circumcision is most easily performed with supplemental opioids.

B is correct. The functional spinal reflex is present by 19 weeks. Sensory fibers are abundant by 20 weeks, and connections to subplate neurons have differentiation by 25 weeks.1,2

Neonatal pain management frequently suffers from:

A. Undertreatment

B. Lack of multimodal analgesia options

C. Limited opioid choices

D. Malfunctioning epidural catheters

A is correct. Historically, neonates were not given analgesic medications for surgery. Although this is no longer the case, pain is still undertreated, and multimodal analgesic methods are underutilized.3,4

How often can peripheral nerve blockade be performed in children in community hospitals?

A. Frequently

B. Rarely

C. Not commonly

D. Nearly always

C is correct. Rural and nonacademic centers are lacking in pediatric pain management options. In particular, peripheral nerve blocks and pain-controlled analgesia (PCA) devices are often not provided.5

Inadequate analgesia for newborn circumcision may result in:

A. Minimal hemodynamic changes

B. Long-term behavioral changes and short-term physiological disturbances

C. Increased bleeding from blood pressure increases

D. Limited changes in behavior

B is correct. As early as birth, lack of adequate analgesia for neonates can have long-term effects.6,7

Which is part of the CRIES pain scale?

A. Requires oxygen < 30%

B. Legs drawn up

C. Inconsolable

D. Heart rate increase > 20 bpm

A is correct. CRIES is a well-known pain scale and has both observed and physiologic components, including ...

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