Journal
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
Volume 27, Issue 10, Pages 851-857Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/EJA.0b013e328338c4af
Keywords
analgesics; anticonvulsants; clonidine; gabapentin; narcotic antagonists; non-steroidal antiinflammatory drugs; opioid; pain; pregabalin; regional anesthesia techniques
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Acute and chronic pain management in children is increasingly characterized by either a multimodal or a preventive analgesia approach, in which smaller doses of opioid and nonopioid analgesics, such as nonsteroidal anti-inflammatory drugs, local anaesthetics, N-methyl-D-aspartate antagonists, alpha(2)-adrenergic agonists, and voltage-gated calcium channel alpha-2 delta-proteins, are combined alone and in combination with opioids to maximize pain control and minimize drug-induced adverse side effects. A multimodal approach uses nonpharmacological complementary and alternative medicine therapies too. These include distraction, guided imagery, hypnosis, relaxation techniques, biofeedback, transcutaneous electrical nerve stimulation, and acupuncture. Using the neurophysiology of pain as a blueprint, the molecular targets and strategies used in multimodal pain management are described. Finally, weight-based dosage guidelines for commonly used opioid and nonopioid analgesics are provided to facilitate therapy. Eur J Anaesthesiol 2010; 27:851-857
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