Perioperative analgesia and assessment of pain in children (literature review)

Annotation. Adequacy of postoperative analgesia and pain assessment remains a pressing issue in children. In order to provide effective pain management to this population, it is important to consider some specific features such as the age of a child, cognitive imparement, mechanisms of pain, and traumatic cimcumstances resulted in nociceptive responses. Therefore, it is essential for clinicians to be able to choose the appropriate tools for pain assessment in different age groups of children and clinical situations, and to interpret the obtained data correctly. Hence, our study aimed to systematize existing problematic aspects of postoperative pain assessment is children and to analyze the evidence on perioperative analgesia in the paediatic practice. For this purpose, we systematically searched MEDLINE, the Cochrane Library and Google Scholar for trials published between 2002-2020. We paid particular attention to the correct choice of pain assessment tools in children of different age groups, and proper interpretation of the data obtained. The study contains the updated recommendations for postoperative pain management in children. There is a special emphasis on priority of multimodal analgesia in children. Analysis of recent publications shows that newborns and children under 5 years of age should be assessed with comprehensive pain scales that include behavioral characteristics and physiological parameters. It is advisable to use self-assessment pain scales for children older than 5 years of age. In order to manage the acute pain effectively, it should be assessed at least every 4-6 hours. Sufficient perioperative analgesia promotes rapid rehabilitation and prevents children from postoperative homeostatic disruption.