Pediatric Postoperative Pain

1
Pediatric Postoperative Pain

• R3 ???
  

2
Anatomic and Physiologic Differences

• Total body water
• full-term newborns 80
• drops to 60 by 2 yrs of age
• greater volume of distribution for water-soluble
  drugs
• Cardiac output
• hibger than adults
• rapid equilibration
• immaturity of the blood-brain barrier
• gt lead to higher CNS

3

• Renal and hepatic blood flow ??
• serum albumin AAG?? ???? ??? ??
• pain pathway? ??? ??
• spinal cord ? ?? ??
• gt damage chance ??

4
Pain Assessment

• ??? ?? (3?? ??? ??)

5
(No Transcript)
6
Nonopioid Analgesics

• Acetaminophen
• oral? ??? rectal? ??
• ??? ?? ??? ??
• ?? ?? ??
• dosage ??? ? ??? ??
• hepatotoxicity? ??? ?? ? ??? ??? ??

7

• NSAIDs
• i.v. ketorolac
• ????? ???? ?? ??? ??
• tonsillectomy ?? ????? ???
• side effect bleeding, renal damage, gastritis
• acetaminophen? combination?? ?? ?
• Aspirin (Acetylsalicylic Acid)
• Reye synd.

8
(No Transcript)
9
Opioid Analgesia

• PCA
• ??? ?? ??? ??
• Patient/Nurse-Assisted Analgesia
• ??? ??? ????
• Continuous Intravenous Infusions
• higher plasma concentration, longer duration
• 6-12??? ??? ??? ????

10
(No Transcript)
11
(No Transcript)
12
Regional Analgesia

• "Single-Shot" Caudals
• ?? ?? ??
• ???? ??? ??
• bupivacaine 0.125 0.25
• 0.51.5mL/kg, upper limit 20mL
• Continuous Epidural Infusions
• infusion rate? ??? (46?? ????)
• ??? ?? GA? ????

13
(No Transcript)
14
Pain Management During Pregnancy and Lactation

• ???? ???? ??? ????, ??? ????
• ??? ????? ?? ??? gestational age? age, ??? ???
  ??, ??? ??? ?? ???

15
Drugs During Pregnancy

• Pharmacokinetic Changes During Pregnancy
• renal elimination??, hepatic metabolism?? ??? ??
  ??, total body water??, protein binding??
• Transfer of Drugs Across the Placenta
• ??? ???? ?? ?? ???? ???
• marternal CO, fetal CO, placental binding,
  placental metabolism, passive diffusion across
  the placenta

16

• marternal plasma levels of a drug
• site of administration, total dose, dosing
  interval, ?? ?????? (ex. epinephrine)
• Teratogenicity
• gestational age of the fetus
• structural malformation functional behavioral
  effects
• LMP ?? 31??? 71???

17

• Food and Drug Administration Risk Classification

18

• Specific Drugs
• aspirin gastroschisis
• ibuprofen, naproxen ? ?? ??
• PGi narrowing of the ductus arteriosus
• full-dose aspirin full-dose NSAIDs? ??
• acetaminophen DOC

19

• Opioids teratogenicity ??? ?? ??
• ??? ???acetaminophen?
• hydrocodone or oxycodone ????
• Bupivacaine, lidocaine ?? ????
• Steroid orofacial clefts
• SSRI, TCI ???? ????
• Phenytoin, carbamazepine, valproic acid
• fetal dysmorphic synd.
• Ergotamine ??
• ?-blocker teratogenicity? ??? IUGR??

20
Drug During Lactation

• Milk to plasma (MP)ratio
• Infant plasma concentration
• 12 of the milk concentration
• Short acting drug??
• American Academy of Pediatrics
• Is drug therapy really necessary?
• The safest drug should ve chosen, e.g.,
  acetaminophen rather than aspirin for mild
  analgesia
• If there is a possibility of risk to the infant,
  then one should considering monitoring infant
  serum levels of the drug
• Having the mother take the medication just after
  she has breast fed the infant or before the
  infant is due to sleep can minimize drug exposure

21
(No Transcript)
22
Imaging During Pregnancy

• 15th week????? ???
• MRI 1st trimester??? ???
• US? ?? ??

23
Pain Syndromes During Pregnancy Lactation

• Back Pain M/C
• Pain ?? lateral to the lumbosacral junction,
  radiate to the post.thigh
• Radicular pain? ?? ???
• Bed?? ???? ?? ??
• Tranditional consevative tech.? ?? ??
• Acetaminophen DOC
• Epidural steroid