Page 16 Acute Pain Management

9.10 Prehospital analgesia ............................................................................................... 294
9.10.1 Assessment of pain in the prehospital environment ........................................295
9.10.2 Systemic analgesics ...........................................................................................295
9.10.2 Anxiolytics .........................................................................................................297
9.10.3 Regional analgesia.............................................................................................297
9.10.4 Non‐pharmacological management of pain......................................................297
CONTENTS References ....................................................................................................................... 299
9.10.5 Analgesia in specific conditions.........................................................................298

10. THE PAEDIATRIC PATIENT ......................................................................................... 335
10.1 Developmental neurobiology of pain ....................................................................... 335
10.2 Long‐term consequences of early pain and injury..................................................... 336
10.3 Paediatric pain assessment ...................................................................................... 336
10.3.1 Pain assessment in neonates ............................................................................337
10.3.2 Observational and behavioural measures in infants and children....................338
10.3.3 Self‐report in children and adolescents ............................................................338
10.3.4 Children with cognitive impairment..................................................................339
10.4 Management of procedural pain.............................................................................. 342
10.4.1 Procedural pain in the neonate.........................................................................343
10.4.2 Procedural pain in infants and older children ...................................................343
10.4.3 Immunisation pain in infants and children........................................................345
10.4.4 Procedural pain management in the emergency department..........................345
10.5 Analgesic agents ...................................................................................................... 347
10.5.1 Paracetamol ......................................................................................................347
10.5.2 Non‐selective non‐steroidal anti‐inflammatory drugs ......................................348
10.5.3 Coxibs ................................................................................................................349
10.5.4 Opioids and tramadol........................................................................................350
10.5.5 Corticosteroids ..................................................................................................352
10.5.6 Other pharmacological therapies......................................................................352
10.6 Opioid infusions and PCA ......................................................................................... 353
10.6.1 Opioid infusions.................................................................................................353
10.6.2 Patient‐controlled analgesia .............................................................................354
10.6.3 Nurse‐controlled analgesia ...............................................................................354
10.7 Regional analgesia ................................................................................................... 355
10.7.1 Peripheral nerve blocks.....................................................................................355
10.7.2 Central neural blockade ....................................................................................357
10.8 Acute pain in children with cancer ........................................................................... 361
10.8.1 Cancer‐related pain...........................................................................................361
10.8.2 Procedure‐related pain .....................................................................................361
10.8.3 Treatment‐related pain.....................................................................................362
References ....................................................................................................................... 363

xvi Acute Pain Management: Scientific Evidence