The Treatment of Pediatric Pain in Spain: A Survey Study.

Pain is a common experience among children and adolescents, and pain management in this population is a challenge to clinicians. The aims of this study were to increase our understanding of current practices in the management of both acute and chronic pediatric pain in Spain, explore potential barriers to ideal practices, and identify professional needs as perceived by healthcare professionals. A total of 277 healthcare professionals took part, all of whom had wide experience in managing children and adolescents with pain (M [SD] age = 44.85, [10.73]; 75% women). Participants had to respond to a web-based survey with 50 questions related to pain education, organizational characteristics of their pain programs (including the characteristics of the patients treated), and current practices in the assessment and treatment of children and adolescents with pain. Almost all the participants (93%) acknowledged important gaps in their training, and only 47% reported that they had received specific education on the management of pediatric pain during their undergraduate and postgraduate studies. A third (31%) were members of multidisciplinary teams, and almost all (99%) understood that protocols to guide the management of pain in young people were necessary. However, only a few of them used a protocol to assess and treat (56% and 48%, respectively) acute and chronic pain (24% and 23%, respectively). The data also showed that a lack of pain education, coordination of professionals, and guidelines was perceived as an important barrier in the care provided to children and adolescents with pain in Spain. The findings of this study can now be used by healthcare professionals in Spain interested in managing pediatric pain, as well as policymakers concerned to improve the education of professionals and the care given to young people with pain.

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery.

INTRODUCTION: In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. MATERIALS AND METHODS: Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with "patient-controlled analgesia" (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55-127), with no differences between the groups. RESULTS: PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). CONCLUSION: PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

The influence of age on the anatomical variability of sciatic nerve divisions in the thigh: an ultrasound study.

PURPOSE: The Sciatic Nerve Division (SND) into the Common Peroneal Nerve and Tibial Nerve presents a great anatomical variability in its location in the thigh, but the influence of age on it has not been fully addressed. METHODS: Anatomical distances from greater trochanter to SND and from SND to popliteal crease were obtained by ultrasound examination in 60 children (age 1-12 years) and 60 adult patients (age 13-80 years) who were scheduled for programmed surgery. A sciatic nerve/thigh coefficient [Greater Trochanter-SND/(Greater Trochanter-popliteal crease)*100] and its coefficient of variation (standard deviation/mean*100) were calculated. Greater Trochanter-SND and SND-Popliteal crease were also correlated with patients´ age, weight and height. RESULTS: There were statistically significant differences between children and adult in Greater Trochanter-SND (20.5 ± 5,5 vs 33.9 ± 2.7; p < 0.0001) and in SND-Popliteal (4.9 ± 2.1 vs 6.7 ± 1.6; p < 0.0001) distances measured in cm. There were also statistically significant differences between children and adults in Sciatic nerve/thigh coefficient (80% vs 83%; p < 0.0001) and its index of variation (8.1% vs 4.8%; p < 0.0001). In children, both Greater Trochanter-SND and SND-Popliteal distances were strongly correlated with age (r2 = 0.868 and r2 = 0.261, respectively; p < 0.0001), weight (r2 = 0.778 and r2 = 0.278, respectively; p < 0.0001) and height (r2 = 0.898 and r2 = 0.225, respectively; p < 0.0001). However, in older patients, only Greater Trochanter-SND distance was statistically correlated with height (r2 = 0.372; p = 0.0001) and not with age or weight; SND-Popliteal distance did not show statistically relevant correlation, either. CONCLUSION: Children presented even more anatomical variability than adults in sciatic nerve division due to the growth of both the proximal and distal nervous structures of the thigh before 12 years of age.

The management of pediatric chronic pain in Spain: a web-based survey study.

OBJECTIVE: To improve understanding of current practices in the treatment of children and adolescents with chronic pain in Spain. METHODS: A web-based survey was conducted with a representative sample of healthcare professionals (i.e. general practitioners [GP] and pediatricians [P]) in Spain. The survey included 23 questions on the pain education and training they had been given, and on organizational issues and current practices in the assessment and management of children and adolescents with chronic pain in their current work. RESULTS: The survey was completed by 191 professionals (75 GP and 116 P) with wide experience (mean number of years = 21; SD = 8) in the management of children and adolescents with chronic pain. Half of the participants reported that they had not been given any specific education or training on pediatric chronic pain management during their studies, and 80% acknowledged important gaps in their training. Although the majority assessed pain when attending children with chronic pain (80%), and almost all (96%) believed that protocols to guide the management of chronic pain in young people were necessary, only a third reported that they usually use a specific protocol. Less than 25% were part of a multidisciplinary team addressing the needs of children and adolescents with chronic pain. CONCLUSIONS: This survey has identified considerable limitations in the management of children and adolescents with chronic pain in Spain. This information can now be used by policy makers to improve the care given to children and adolescents suffering from chronic pain and their families.

Authorship Correction: The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology.

[This corrects the article DOI: 10.2196/16013.].

A Cohort of Patients with COVID-19 in a Major Teaching Hospital in Europe.

BACKGROUND: Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the region of Madrid. This article describes the first 2226 adult patients with COVID-19, consecutively admitted to La Paz University Hospital in Madrid. METHODS: Our cohort included all patients consecutively hospitalized who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from 25 February (first case admitted) to 19 April 2020. The data were manually entered into an electronic case report form, which was monitored prior to the analysis. RESULTS: We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients' median age was 61 years, and 51.8% were women. The most common comorbidity was arterial hypertension (41.3%), and the most common symptom on admission was fever (71.2%). The median time from disease onset to hospital admission was 6 days. The overall mortality was 20.7% and was higher in men (26.6% vs. 15.1%). Seventy-five patients with a final outcome were transferred to the intensive care unit (ICU) (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. CONCLUSIONS: We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male sex, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.

The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology.

BACKGROUND: Patients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings. OBJECTIVE: The main objective of this study was to assess the association between the use of EVGs and the intensity of pain caused by chemotherapy-induced mucositis in pediatric patients with cancer. The secondary objective was to assess the association between changes in pain intensity and sympathetic-parasympathetic balance in this sample of pediatric patients. METHODS: Clinical records were compared between the day prior to the use of EVGs and the day after the use of EVGs. The variables were variations in pupil size measured using the AlgiScan video pupilometer (IDMed, Marseille, France), heart rate variability measured using the Analgesia Nociception Index (ANI) monitor (Mdoloris Medical Systems, Loos, France), intensity of pain measured using the Numerical Rating Scale (score 0-10), and self-administered morphine pump parameters. RESULTS: Twenty patients (11 girls and nine boys; mean age 11.5 years, SD 4.5 years; mean weight 41.5 kg, SD 20.7 kg) who met all the inclusion criteria were recruited. EVGs were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes. After playing EVGs, there was significantly lower daily morphine use (before vs after playing EVGs: 35.9 vs 28.6 µg/kg/day, P=.003), lower demand for additional pain relief medication (17 vs 9.6 boluses in 24 hours, P=.001), lower scores of incidental pain intensity (7.7 vs 5.4, P=.001), lower scores of resting pain (4.8 vs 3.2, P=.01), and higher basal parasympathetic tone as measured using the ANI monitor (61.8 vs 71.9, P=.009). No variation in pupil size was observed with the use of EVGs. CONCLUSIONS: The use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine.

Possible role of highly activated mucosal NK cells against viral respiratory infections in children undergoing haematopoietic stem cell transplantation.

Infection is the leading cause of non-relapse-related mortality after allogeneic haematopoietic stem cell transplantation (HSCT). Altered functions of immune cells in nasal secretions may influence post HSCT susceptibility to viral respiratory infections. In this prospective study, we determined T and NK cell numbers together with NK activation status in nasopharyngeal aspirates (NPA) in HSCT recipients and healthy controls using multiparametric flow cytometry. We also determined by polymerase chain reaction (PCR) the presence of 16 respiratory viruses. Samples were collected pre-HSCT, at day 0, +10, +20 and +30 after HSCT. Peripheral blood (PB) was also analyzed to determine T and NK cell numbers. A total of 27 pediatric HSCT recipients were enrolled and 16 of them had at least one viral detection (60%). Rhinovirus was the most frequent pathogen (84% of positive NPAs). NPAs of patients contained fewer T and NK cells compared to healthy controls (p = 0.0132 and p = 0.120, respectively). Viral PCR + patients showed higher NK cell number in their NPAs. The activating receptors repertoire expressed by NK cells was also higher in NPA samples, especially NKp44 and NKp46. Our study supports NK cells relevance for the immune defense against respiratory viruses in HSCT recipients.

[Treatment for children and adolescents with pain in Spain: data from a survey on current specialized programs]. / El tratamiento del dolor en población infantojuvenil en España: Datos de una encuesta sobre los programas especializados existentes.

OBJECTIVE: The treatment of children and adolescents with pain has improved considerably in the last 30 years. In Spain, progress is also evident, and specialized units or programs have emerged as part of the care provided for this population. However, there are no studies on the characteristics or activities of these specialized units or programs. This lack of information prevents an adequate evaluation of the current procedures, and hinders an adequate administration and management of these resources. The objective of this work was to study the characteristics of these units and programs for the treatment of children and adolescents with pain in Spain. METHODS: A total of 10 specialized units or specific treatment programs for pediatric pain in Spain were identified, and the person responsible was contacted. Through a self-administered online survey, information was collected on the organization of the program, the involvement in relevant fields such as research, training of professionals and the raising of awareness and visibility of the problem, the specialties involved, the type of treatments offered, the evaluation of results and the services provided. RESULTS: Of the ten units or programs contacted, eight answered the survey (80%). Pain programs for children and adolescents proved to be primarily pharmacological, also for chronic pain. They reported to promote awareness about the problem (88%), to contribute to the training of specialists (88%) and to a lesser extent to research and knowledge generation (75%). CONCLUSIONS: This survey provides valuable information on the current characteristics of specialized programs and units for the treatment of children and adolescents with pain in Spain, and can be used to propose actions that improve its current management and administration.

OBJETIVO: El tratamiento de la población infantojuvenil con dolor ha mejorado considerablemente en los últimos 30 años. En España, el progreso también es evidente, y han surgido unidades o programas especializados como parte de la atención a esta población, aunque no existen estudios sobre las características o la actividad de estas unidades o programas especializados. Esta falta de información impide una evaluación adecuada de los procedimientos vigentes y dificulta una adecuada administración y gestión de estos recursos. El objetivo de este trabajo fue conocer las características de estas unidades y programas para el tratamiento de la población infantojuvenil con dolor en España. METODOS: Se identificaron un total de 10 unidades especializadas o programas de tratamiento específicos del dolor infantil en España y se contactó con la persona responsable. A través de una encuesta autoadministrada online se recogió información sobre la organización del programa, su implicación en ámbitos relevantes como la investigación, la formación de los profesionales, la sensibilización y visibilidad del problema en la sociedad y entre los profesionales, las especialidades implicadas, el tipo de tratamientos que se ofrecen, la evaluación de resultados y los servicios prestados. Se han utilizado medias y porcentajes para describir los resultados. RESULTADOS: De las diez unidades o programas contactados, ocho contestaron a la encuesta (80%). Los programas de tratamiento del dolor infantojuvenil demostraron ser fundamentalmente farmacológicos, también en los casos de dolor crónico. Informaban de que se preocupaban por impulsar la sensibilización de los especialistas y la sociedad sobre el problema (88%), de contribuir también a la formación de especialistas (88%) y, en menor medida, de investigar y generar conocimiento (75%). CONCLUSIONES: Esta encuesta proporciona información valiosa sobre las características actuales de los programas y unidades especializadas para el tratamiento de la población infantojuvenil con dolor en España. Puede servir para proponer acciones que mejoren la gestión y administración actual.

Pain curricula across healthcare professions undergraduate degrees: a cross-sectional study in Catalonia, Spain.

BACKGROUND: Pain management is a challenge and effective treatment requires professionals to collaborate if they are to address the needs of patients with pain. Comprehensive education and training is key to helping skilled professionals provide the best pain care possible. The objective of this work was to study the content of the pain education provided to undergraduates in healthcare and veterinary programs in Spain. METHODS: A survey was developed on the basis of previous surveys that had been used in the field. The final version included 31 questions about different issues on pain education, including, type of subject, number of pain mandatory/elective hours, and specific content covered. The survey was sent to all course leaders for all subjects on the undergraduate programs in Dentistry, Human Nutrition and Dietetics, Medicine, Nursing, Occupational Therapy, Pharmacy, Physiotherapy, Podiatry, Psychology, and Veterinary Science, in Catalonia, Spain. The survey was conducted from January to June, 2018. Students' t-test were used to study mean differences in responses. RESULTS: A total of 550 course leaders from all healthcare undergraduate programs in Catalan universities took part. There were considerable differences in the number of pain-related hours among disciplines: Nursing reported the highest number of hours, and Psychology the lowest. The area least covered by all the disciplines was the "Management of pain", and particularly the content related to the most vulnerable members of society (i.e., youths, the elderly and special populations). No interprofessional educational program on pain was identified. CONCLUSIONS: Pain is not such a large component of the undergraduate healthcare curriculum in Spain as could be expected given the extent of pain and its impact. Curricula need to be changed so that the problems all stakeholders have with pain care can be addressed.

El tratamiento del dolor en población infantojuvenil en España: Datos de una encuesta sobre los programas especializados existentes / Treatment for children and adolescents with pain in Spain: data from a survey on current specialized programs

OBJETIVO: El tratamiento de la población infantojuvenil con dolor ha mejorado considerablemente en los últimos 30 años. En España, el progreso también es evidente, y han surgido unidades o programas especializados como parte de la atención a esta población, aunque no existen estudios sobre las características o la actividad de estas unidades o programas especializados. Esta falta de información impide una evaluación adecuada de los procedimientos vigentes y dificulta una adecuada administración y gestión de estos recursos. El objetivo de este trabajo fue conocer las características de estas unidades y programas para el tratamiento de la población infantojuvenil con dolor en España. MÉTODOS: Se identificaron un total de 10 unidades especializadas o programas de tratamiento específicos del dolor infantil en España y se contactó con la persona responsable. A través de una encuesta autoadministrada online se recogió información sobre la organización del programa, su implicación en ámbitos relevantes como la investigación, la formación de los profesionales, la sensibilización y visibilidad del problema en la sociedad y entre los profesionales, las especialidades implicadas, el tipo de tratamientos que se ofrecen, la evaluación de resultados y los servicios prestados. Se han utilizado medias y porcentajes para describir los resultados. RESULTADOS: De las diez unidades o programas contactados, ocho contestaron a la encuesta (80%). Los programas de tratamiento del dolor infantojuvenil demostraron ser fundamentalmente farmacológicos, también en los casos de dolor crónico. Informaban de que se preocupaban por impulsar la sensibilización de los especialistas y la sociedad sobre el problema (88%), de contribuir también a la formación de especialistas (88%) y, en menor medida, de investigar y generar conocimiento (75%). CONCLUSIONES: Esta encuesta proporciona información valiosa sobre las características actuales de los programas y unidades especializadas para el tratamiento de la población infantojuvenil con dolor en España. Puede servir para proponer acciones que mejoren la gestión y administración actual

OBJECTIVE: The treatment of children and adolescents with pain has improved considerably in the last 30 years. In Spain, progress is also evident, and specialized units or programs have emerged as part of the care provided for this population. However, there are no studies on the characteristics or activities of these specialized units or programs. This lack of information prevents an adequate evaluation of the current procedures, and hinders an adequate administration and management of these resources. The objective of this work was to study the characteristics of these units and programs for the treatment of children and adolescents with pain in Spain. METHODS: A total of 10 specialized units or specific treatment programs for pediatric pain in Spain were identified, and the person responsible was contacted. Through a self-administered online survey, information was collected on the organization of the program, the involvement in relevant fields such as research, training of professionals and the raising of awareness and visibility of the problem, the specialties involved, the type of treatments offered, the evaluation of results and the services provided. RESULTS: Of the ten units or programs contacted, eight answered the survey (80%). Pain programs for children and adolescents proved to be primarily pharmacological, also for chronic pain. They reported to promote awareness about the problem (88%), to contribute to the training of specialists (88%) and to a lesser extent to research and knowledge generation (75%). CONCLUSIONS: This survey provides valuable information on the current characteristics of specialized programs and units for the treatment of children and adolescents with pain in Spain, and can be used to propose actions that improve its current management and administration

Anatomical comparison of sciatic nerves between adults and newborns: clinical implications for ultrasound guided block.

The sciatic nerve (SN) is easily blocked under ultrasound guidance by identifying either the SN common trunk or its two components: the tibial nerve (TN) and the common peroneal nerve (CPN). The authors investigate whether there are anatomical differences between newborns and adults. The SN, TN and CPN of both lower extremities in 24 (11 neonatal and 13 adults) formolized cadavers were dissected. Distances were measured from the origin of the SN (passing under the piriformis muscle) to its division into TN and CPN, and from there to the popliteal crease. The sciatic/thigh coefficient (proportion relating SN length to thigh length) and the variation coefficient for the SN were calculated. The distance from the popliteal crease to the SN division was significantly shorter in neonates than in adults (1.04 ± 0.9 cm vs. 5.6 ± 5.1 cm, P = 0.0003). In addition, the neonatal SN divided at a proportionally more distal position in the thigh than it did in adults (86 ± 13 vs. 74 ± 15%, P = 0.0059). However, the coefficient of variation between the SN-division distances was not statistically different in infants and adults (12.8 vs. 18.2%, P = 0.4345). The variations in the point of SN division seen in the adult SN are already seen in the neonatal period, but in newborns the SN divided in a more distal position in relation to the thigh than in adults, so this finding of anatomical variability in neonates suggests that ultrasound guidance can be useful when performing a SN block in these small patients.

Equimolar nitrous oxide/oxygen versus placebo for procedural pain in children: a randomized trial.

OBJECTIVE: This randomized, single-dose, double-blind, Phase III study was designed to compare the level of procedural pain after use of premixed equimolar mixture of 50% oxygen and nitrous oxide (EMONO) or placebo (premixed 50% nitrogen and oxygen). METHODS: Patients aged 1 to 18 years were randomly assigned to receive EMONO (n = 52) or placebo (n = 48) delivered by inhalation through a facial mask 3 minutes before cutaneous, muscle, or bone/joint procedures. Pain was evaluated (on a scale from 0-10) using a self-reported Faces Pain Scale-Revised (FPS-R) or a Spanish observational pain scale (LLANTO). Rescue analgesia (with propofol or sevoflurane) was administered if pain scores were greater than or equal to 8. Collaboration, acceptance, ease of use and safety were evaluated by the attending nurse. RESULTS: There were significant differences between the 2 groups (EMONO versus placebo) for both scales (mean values): LLANTO: 3.5 vs 6.7, respectively (P = .01) and FPS-R: 3.2 vs 6.6, respectively (P = .0003). Patients not receiving EMONO (P = .0208)-in particular those aged younger than 3 years (P < .0001)-required more rescue analgesia. There were also significant differences between the 2 groups (EMONO versus placebo) for adequate collaboration (80% vs 35%; P < .0001) and acceptance (73% vs 25%; P < .0001). Ease of use was not significantly different between groups (98.1% vs 95.8%; P > .05). Only 2 patients (in the EMONO group) presented with mild adverse events. CONCLUSIONS: EMONO inhalation was well tolerated and had an estimated analgesic potency of 50%, and it is therefore suitable for minor pediatric procedures.

[Measuring quality of life in children with chronic pain: has it any clinical advantage?]. / Medición de calidad de vida en niños con dolor crónico: ttiene alguna utilidad clínica?

Lately, interest in studying quality of life as a possible target aim in clinical practice has been encouraged. Currently, increasing survival with a therapeutic treatment cannot be considered valid unless the quality of that survival is also improved. Several scales and different tools for measuring quality of life have been development for research in clinical assays and then incorporated in clinical practice. In fact, in patients with chronic pain, it would seem to be more important to measure these factors, rather than measuring their survival. Health related quality of life in children can be measured with specific and well selected scales. Abundant reports relate chronic pain in children with a progressive loss of quality of life. This relationship between pain and quality of life can be used in preverbal children to evaluate pain and so these scales could offer several clinical advantages.

Programa de implementación de una unidad de dolor agudo pediátrico / Program to implement pediatric acute pain units

Objetivo: Describir la implantación, el desarrollo y la gestión de una unidad de dolor agudo en un hospital pediátrico. Material y métodos: Se realizó una consulta y análisis de fuentes científicas sobre dolor agudo, dolor infantil, unidades de dolor agudo y protocolos de dolor infantil. Se hizo una selección de los artículos más relevantes sobre el tema en los idiomas inglés y español en libros, revistas, publicaciones y páginas web de anestesiología, de dolor y de enfermería. Las fuentes analizadas y consultadas abarcaron el período comprendido entre los años 1988 y 2007. Resultados: Con la información obtenida se elaboró un documento de actualización acerca de la situación del dolor infantil. Se confeccionó un programa con las bases principales para la puesta en marcha de una unidad de dolor agudo en un hospital infantil. Para ello se seleccionaron destacados modelos de implementación y gestión de servicios de dolor, así como protocolos de actuación y vías clínicas de dolor infantil para el desarrollo de dicho programa. Conclusiones: Mediante la utilización de los métodos tradicionales y de los más nuevos en terapia del dolor es posible brindar una analgesia eficaz prácticamente a todos los pacientes, pero para que esos tratamientos sean aplicados correctamente es necesario contar con una infraestructura establecida. Uno de los recursos más importantes de los que se dispone en la actualidad es la implementación de una organización formal, como las unidades de dolor agudo infantil, con la intención de brindar una calidad asistencial de excelencia que optimice el uso de las técnicas analgésicas existentes con la máxima seguridad y con el mínimo de efectos secundarios posible.

Objective: The aim of this article is to describe the location, development and management of Acute Pain Unit at a children's hospital. Material and Methods: A scientific research has been made about acute pain, pain in children, acute pain units and pediatric protocols. A selection has be en made of the most significant books, magazines, journals and web sites in both Spanish and English. The research took place between the years 1988 and 2001 Results: Information about child pain was updated with the data obtained. A program with the main bases was designed in order to set up an Acute Pain Unit at a children's hospital. To do so, notable prototypes of pain management units were chosen and distinguished protocols and guides of pediatric pain and its treatment have been taken as standards. Conclusions: Through the use of traditional and new techniques for the treatment of pain, it is possible to give an effective analgesia to almost all patients. But for the correct development of these treatments it is necessary to establish a formal organization. Nowadays, one of the most convenient options are the pediatric acute pain units, which offer excellent medical assistance, as well as the rational use of existing analgesic techniques with the greatest security and the minimum side effects.

Objetivo: O objetivo deste trabalho é descrever a execução, o desenvolvimento e a gestáo de uma unidade de dor aguda em um hospital pediátrico. Material e métodos: Foram consultados e analisados fontes científicas sobre dor aguda, dor infantil, unidades de dor aguda e protocolos de dor infantil. Selecionamos os artigos mais relevantes sobre o tema, nas línguas inglesa e espanhola, em livros, revistas, publicações e páginas web de anestesiologia, de dor e de enfermaria. As fontes analisadas e consultadas abrangeram o período compreendido entre os anos 1988 e 2001 Resultados: Com a informação obtida, foi elaborado um documento de atualização acerca da situação da dor infantil. Preparou-se um programa com as bases principais para a posta em marcha de uma unidade de dor aguda em um hospital infantil. Para isso, foram escolhidos destacados modelos de execugáo e gestáo de servigos de dor, bem como protocolos de atuagáo e vias clínicas de dor infantil para o desenvolvimento desse programa. Conclusoes: Utilizando métodos tradicionais e modernos em terapia da dor, é possível proporcionar analgesia eficaz praticamente a todos os pacientes; no en tanto, a correta aplicação desses tratamentos exige contar com urna infraestrutura estabelecida. Um dos recursos mais importantes disponíveis atualmente é a execução de uma organização formal, como as unidades de dor aguda infantil, a fim de proporcionar uma qualidade assistencial de excelêcia que aperfeiçoe o uso das técnicas analgésicas existentes com segurança máxima e o mínimo de efeitos secundários possível.