Acute Pain Management in Hospitalized Children.

BACKGROUND: Acute pain in hospitalized pediatric patients is prevalent. Recent shifts in the paradigm of pediatric acute pain management focus less on reliance on opioids, due to their adverse side effects and risk of dependence, and more on multimodal pain management. OBJECTIVE: We sought to review the most recent studies on acute pain management in hospitalized pediatric patients. METHOD: We searched the Cochrane Database and PubMed for articles published in the past five years regarding the treatment of acute pain in pediatric patients focusing on large randomized or quasirandomized controlled trials, cohort trials, and meta-analyses. RESULTS: We categorized results into non-pharmacological, localized, non-opiate pharmacological, and opiate based therapies. Recent studies show that environmental and non-pharmacological methods of pain management are efficacious in infants. School aged children benefit from active distraction more than passive distraction. Needleless methods of introducing lidocaine locally alleviate the pain associated with many procedures to which hospitalized children are exposed. The shift towards use of nonopiate pharmacology focuses on novel means of utilizing older medications, such as intravenous parecoxib, inhaled methoxyflurane, and sublingual ketorolac or tramadol and the avoidance of codeine. CONCLUSION: Acute pediatric pain management has changed to emphasize multimodal and multidisciplinary therapy. In all children, non-pharmacological therapies should be employed routinely. Given the myriad tools available, pediatric acute pain services have developed in order to integrate more advanced treatments such as nerve blocks and infusions of centrally acting pain modulators.