Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Severity of pain:Minor or outpatient procedures require oral opioids or NSAIDs to complement any regional anesthesia blockMajor surgery requires regional anesthesia, if applicable, and scheduled or continuous opiate administration with NSAIDs, benzodiazepines, or other pain medications as indicatedType of surgery:Abdominal: regional, opioids, NSAIDs, multimodalThoracic: regional strongly recommended, opioids, NSAIDs, multimodalLaparoscopic: opioids, NSAIDs, local infiltrationNeurosurgical: opioids, infiltration regional (less loss of motor function in neurologic exam), avoid sedation, generally avoid NSAIDsENT: opioids, avoid sedation in airway compromise, avoid NSAIDs in T&AOrthopedic: regional anesthesia, benzodiazepines and antispasmodics, opioids, NSAIDsPlastic: opioids, NSAIDS for minor surgery—avoid in reconstructive surgery, local infiltrationOphthalmologic: opioids, topical local anesthetics, NSAIDsUrologic: regional anesthesia—caudals, opioids, NSAIDs, antispasmodics (bladder)Cardiac: opioids, NSAIDs, regional anesthesia (neuraxial based on postoperative coagulation plan)Age and size of child:Weight-based dosing regimens to account for various sizes of children, ideal weight-based dosing for obese adolescentsNeonates:Require higher monitoring due to generally narrower therapeutic rangeRequire continuous or scheduled delivery of pain medications due to inability to communicateInfants have similar needs based on decreased communication. Frequent pain evaluation with developmentally appropriate rating scales prevents inadequate treatment of painBy age 4, can communicate differing intensities of painAge 6 or 7: can self-administer medications through patient-controlled analgesia (PCA) and patient-controlled epidural analgesia (PCEA) systems; if they can play a video game, they should cognitively be able to press a button for painUse of regional anesthesia/analgesia:Parents agree to regional anesthesia by experienced providerContraindications: local infection, sepsis, preexisting neurologic condition, allergy or hypersensitivity, coagulation issues per ASRA guidelines for neuraxial anesthesiaComorbidities:Spina bifida and previous spine surgery (myelomeningocele, hardware) and coagulopathy are relative contraindications to neuraxial regional anesthesiaLiver dysfunction requires dosing adjustments for opioids, benzodiazepinesRenal dysfunction requires dosing adjustments for opioids, NSAIDsRespiratory dysfunction including OSA requires dosing adjustment for opioids, benzodiazepines; special consideration with NSAIDs and asthmatic patientsNeurologic dysfunction, central or peripheral deficits are relative contraindications to regional anesthesia ++ Multimodal pain treatment is guided by using different medications at moderate doses to decrease the risk of side effects or toxicity from any one therapyBe flexible and adaptive in treating children’s (and parents’) pain, as all pain is perceived differently—some have more emotional pain; others have more sensory pain ++ Opioids can be delivered through many routes: PO, nasal, IV through PCA, continuous infusion and intermittently, epidural and intrathecalIM and SQ injections should be avoided as young patients have more fear of the delivery method than of the pain itselfLocal anesthetics can be delivered through peripheral injections, peripherally placed catheters, epidural catheters and caudal injections, as well as intrathecal placement. Topical gels and patches are contraindicated on incisionsAdditional treatment medications: NSAIDs, benzodiazepines, NMDA antagonists, alpha-2 antagonists ++Table Graphic Jump Location|Download (.pdf)|PrintTypical Settings for IV Patient-Controlled AnalgesiaDrugDemand dose (μg/kg)Lockout interval ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.