UDK  616.8-009.7-02-053.2                                   

ISSN 2466-2992 (Online) (2022) br. 2, p. 8-14

COBISS.SR-ID 110158089                        

                       



PREHOSPITAL MANAGEMENT OF ACUTE PAIN IN CHILDREN


Vesna Marjanović 1,2 Ivana Budić 1,2, Biljana Stošić 1,2, Mlađan Golubović 1,3,

Velimir Perić 3, Milan Elenkov4, Marija Stević 5,6, Dušica Simić 5,6


1 Faculty of Medicine, University of Niš, Serbia; 2 Clinic for Anesthesiology and Intensive Therapy,

University Clinical Center Niš, Serbia; 3 Clinic of Cardiovascular Surgery, University Clinical Center Niš, Serbia; 4 General Hospital Pirot, 5 Faculty of Medicine, University of Belgrade, Serbia; 6 University Children`s Hospital Tiršova, Belgrade, Serbia


Summary:


Introduction: Acute pain is one of the most commonly seen symptoms in children managed by emergency medicine practitioners. Recognition and treatment of pain in children, differs from the adults. Successful analgesia is achieved in only one third of children in prehospital settings. Treatment of pain must be initiated promptly.


Synthesis: The best method for pain assessment is to get anamnestic data from children or their care givers and/or by following the vital signs. The use of pain scales adopted for child’s age could be of additional help. History data may point toward etiology, anatomic localization, intensity and chronicity of pain. Isolated mo­nitoring of tachycardia, hypertension, tachypnea and other vital signs could be misleading, since these signs could be easily seen in upset and crying children. Initial assessment according to pain scale adopted for child’s age, may provide better identification and quantification of pain. Repeated use of the same scale after analgesics may improve assessment of therapeutic effects. Pain management may be through pharmacologi­cal and nonpharmacological means. Pharmacological approach is based on administration of various analgesics depending on intensity of the pain. In this manner, acetaminophen and non-steroid anti-inflammatory drugs (NSAIDs) are suggested for mild to moderate pain. In the common practice, ibuprofen, naproxen and ketorolac are the most common used NSAIDs. Their dominant application is using the oral or rectal route.  For treatment of medium to higher pain intensity, opiates such as: morphine, fentanyl are re­commended. In case of inadequate response to opiates, ketamine is considered to be an adequate option. If the pain persists, drug may be repeated with a half of the initial dose. In case of higher pain intensity analge­sics should be administered intravenously, intranasally or intraosseously. Intranasal route of analgesics application is recently considered feasible in children without intravenous access or in the absence of tolera­bility. Intranasal administration is well tolerated, noninvasive route, providing rapid drug resorption within 30 minutes. Nonpharmacological technique consists of immobilization and elevation of injured extremity in case of injuries, putting the patient in most comfortable position and the use of attention distraction methods.

  

Conclusion: Treatment of acute pain is crucial part of early management of pediatric patients, since, the inadequate pain control may cause physiological and psychological complications with both short- and long-term consequences.


Key words: pain mangement, pain assessment, analgesics, children, emergency medical services


Note: The work is presented on 7. International Congress of Serbian Society of Emergency Physicians in Niš on October 23-25, 2021 entitled "Prehospital treatment of pain in children"



Correspondence

 

Vesna MARJANOVIĆ

Klinika za anesteziologiju i intenzivnu terapiju

Medicinski fakultet Niš

E-mail:  vesna.marjanovic@medfak.ni.ac.rs ;

drvesnamarjanovic@gmail.com

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