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Chapter 44. Acute and Chronic Pain Management in Children
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Which of the following statements is true regarding neonatal pain infrastructure?
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A. The sensation for pain is not present.
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B. Significant pain structures exist as early as the second trimester.
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C. Hydromorphone is not an effective drug for immature receptors.
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D. Newborn circumcision is most easily performed with supplemental opioids.
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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
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Neonatal pain management frequently suffers from:
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B. Lack of multimodal analgesia options
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C. Limited opioid choices
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D. Malfunctioning epidural catheters
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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
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How often can peripheral nerve blockade be performed in children in community hospitals?
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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
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Inadequate analgesia for newborn circumcision may result in:
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A. Minimal hemodynamic changes
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B. Long-term behavioral changes and short-term physiological disturbances
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C. Increased bleeding from blood pressure increases
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D. Limited changes in behavior
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B is correct. As early as birth, lack of adequate analgesia for neonates can have long-term effects.6,7
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Which is part of the CRIES pain scale?
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D. Heart rate increase > 20 bpm
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A is correct. CRIES is a well-known pain scale and has both observed and physiologic components, including crying, requires ...