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In recent years, improvements in technology, improved understanding of narcotic pharmacology, and enhanced recognition of the needs of children to receive adequate analgesia have all resulted in more complete treatment of pain in children. Children need no longer fluctuate between unconsciousness and uncontrollable pain, awaiting expiration of the "routine" four-hour interval. Young children can be treated with continuous narcotic infusions or continuous epidural infusions, eliminating the pain of a needle every four hours. Older children may, in adclifton, use patient-controlled analgesia (PCA). Increased use of regional anaesthesia has reduced the need for any postoperative narcotics after some surgical procedures, and its increased use as a supplement to general anaesthesia has resulted in an improved postoperative course for many children. Nurses need no longer focus on the last time and dose of analgesia, but on the patient's perception of pain. With PCA the patient determines the frequency and timing of the/v medication he receives. With controlled narcotic infusions, the dose of medication may be painlessly increased, and the nurse need not confront patient fears of intramuscular or subcutaneous injections. With continuous epidural analgesia, patient discomfort is an indication to adjust the medication or the catheter. In some centres, using intermittent narcotic analgesia, the nurse may be certified to administer the next dose of epidural narcotic, which will give a prolonged period of pain relief. Nurses are able to help more, and patients spend less time in pain. To treat pain effectively, the establishment of a pain service is recommended, incorporating multidisciplinary support. The supervision of PCA and continuous epidural analgesia requires the ongoing assessment and revision of therapy by an anaesthetist. As a result of increased involvement in bedside care, anaesthesia staff are now requested to participate in the education of nurses and other professionals regarding the indications for, techniques of managing, and complications of the various modalities which are now used for acute pain control. A collaborator (often a nurse) is required to assist with patient management, establishment of nursing policy, nurse education and administrative support. Pharmacists must establish procedures for assuring availability of epidural medication. Educational responsibilities, quality control issues, and continuing availability of clinical support are all concerns of this multidisciplinary group. Most pain services have been coordinated by anaesthetists because of their technical knowledge, their pharmacological background, and their experience with pain relief.

Pain control in the pediatric patient — the role of anaesthesia