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The ideal prehospital analgesic agent should be simple to use, safe, effective, not lead to
delays in transport and have a rapid onset and short duration of action so that it can be
repeated as often as necessary and titrated to effect for each patient. Consideration
should be given to both choice of analgesic drug and route of administration (N).
Non‐pharmacological measures are effective in providing pain relief and should always
be considered and used if practical (N).
10. THE PAEDIATRIC PATIENT
Long‐term consequences of early pain and injury
SUMMARY Following birth, even the most premature neonate responds to nociceptive stimuli (U).
In early development more generalised reflex nociceptive responses occur in response to
lower intensity stimuli (U).
Due to the increased plasticity of the developing nervous system, pain and injury in early
life may have adverse long‐term consequences (U).
Paediatric pain assessment
Pain assessment and measurement are important components of paediatric pain
management (U).
Pain measurement tools are available for children of all ages (U).
Pain measurement tools must be matched to the age and development of the child, be
appropriate for the clinical context and be explained and used consistently (U).
Management of procedural pain
1. Sucrose reduces the behavioural response to heel‐stick blood sampling in neonates (U)
(Level I [Cochrane Review]).
2. Breastfeeding or breast milk reduces measures of distress in neonates undergoing a
single painful procedure compared to positioning or no intervention (U) (Level I
[Cochrane Review]).
3. Distraction, hypnosis, and combined cognitive‐behavioural interventions reduce pain and
distress associated with needle‐related procedures in children and adolescents (S)
(Level I [Cochrane Review]).
4. EMLA® is an effective topical anaesthetic for children, but amethocaine is superior for
reducing needle insertion pain (N) (Level I [Cochrane Review]).
5. Topical local anaesthetic application, inhalation of nitrous oxide (50%) or the
combination of both provides effective and safe analgesia for minor procedures (U)
(Level I).
6. Combinations of hypnotic and analgesic agents are effective for procedures of moderate
severity (U) (Level II).
Inadequate monitoring of the child, lack of adequate resuscitation skills and equipment,
and the use of multiple drug combinations has been associated with major adverse
outcomes during procedural analgesia and sedation (U).
xlii Acute Pain Management: Scientific Evidence
