REVIEW   Free access

Minerva Anestesiologica 2020 November;86(11):1205-13

DOI: 10.23736/S0375-9393.20.14391-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

What has happened since the First World Congress on Pediatric Pain in 1988? The past, the present and the future

Per-Arne LÖNNQVIST ✉

Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden

The present article summarizes the development within the field of pediatric pain during the last 30 years, with a special focus on pediatric postoperative pain. Insights concerning pain ontogeny, how pain influences the neuro-endocrine stress response and the induction of a “pain memory” is discussed as well as established and new options with regards to treatment of postoperative pain. Lastly, some aspects concerning future development within this field is discussed. It is now well-established that even the unborn fetus reacts with behavioral responses indicative of pain and is also capable of producing a neuro-endocrine stress response if subjected to a painful stimulus. These responses can successfully be treated by opioid administration. The babies stress response if proportional to the magnitude of the surgical procedure and various ways to provide better pain relief to babies undergoing major surgery has been shown to reduce morbidity and mortality. A wide variety of different options exist to treat postoperative pain both in infants and older children. The use of regional anesthetic techniques should be used whenever possible and combined with appropriate systemic options, thereby producing multi-modal analgesia. However, new concepts and drugs are unfortunately few and, thus, progress often lies in using established drugs in more efficient ways. The concept of Enhanced Recovery After Surgery (ERAS) also provides a framework where high-quality postoperative pain relief is of essence for the best possible outcome after both minor and major surgery.

KEY WORDS: Child; Pain management; Opioid analgesics