AAGBI Core Topics in Anaesthesia 2012 by Ian Johnston

Author:Ian Johnston
Language: eng
Format: epub
Publisher: Wiley
Published: 2012-03-16T16:00:00+00:00

Analgesic drugs and techniques

Pain intensity and duration in the perioperative period are usually predictable and planning analgesic requirements is relatively straightforward. Many combinations of drugs and techniques are possible. Potent analgesic combinations are usually required initially, with a gradual reduction over time as healing occurs, and with pain finally being managed with simple, readily available analgesics. Opioids, paracetamol and NSAIDs are usually administered regularly as part of a multimodal strategy. Local anaesthesia can be used in the form of a ‘single-shot’ technique at the time of surgery or as a postoperative infusion either centrally or peripherally. Other agents such as N-methyl-D-aspartic acid (NMDA) antagonists (ketamine) and α2-adrenergic agonists (clonidine) can be added to supplement the multimodal strategy and/or prolong the effect of local anaesthetics.

In other situations, such as pain associated with trauma, medical disease, malignancy or chronic pain syndromes, the predictability of the intensity and duration of the pain may not be clear. Whilst the analgesic drugs and techniques used in the postoperative period may also be appropriate in these situations, the analgesic regimens must be designed with sufficient range and flexibility to allow for easy administration and titration to the child’s needs. However, in some situations in which these first line analgesics are either not working or are known to have limited efficacy, other drugs with analgesic properties such as gabapentin, antidepressants or anticonvulsants may be given. Recommended doses of commonly used analgesics are given in Table 6.3.

Table 6.3 Commonly used analgesic drugs in children.

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