Acute Postoperative Pain Management in Infants and Children: Size and Age Do Matter

Abstract

Anesthesiologists have expertise and experience with both analgesics and regional anesthetic techniques that enable them to optimize perioperative pain relief. This has always been of value to patients and their families. It is particularly so in the modern era of the ‘‘perioperative surgical home,’’ where what anesthesiologists do in the operating room and beyond may improve time to discharge and decrease unplanned returns to the hospital. Much of the discussion in this chapter includes ‘‘offlabel’’ or ‘‘unapproved’’ use of drugs, as this practice remains common in children despite recent laws promoting the need for more study and inclusive labeling for infants and children. Unapproved use does not imply improper or illegal use of such drugs. An in-depth review of developmental pharmacokinetics and pharmacodynamics in newborns and infants is beyond the scope of this discussion, but is available to the interested reader in any of several pediatric anesthesia textbooks.