TY - CHAP M1 - Book, Section TI - Chapter 165. Pediatric Postoperative Analgesia A1 - Kraemer, F. Wickham A2 - Atchabahian, Arthur A2 - Gupta, Ruchir PY - 2013 T2 - The Anesthesia Guide AB - 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 SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=57263159 ER -