Japanese

Title	小児の術後鎮痛の基本と注意点
Subtitle	推薦演題
Authors	篠崎友哉*
Authors (kana)
Organization	*宮城県立こども病院 麻酔科
Journal	日本小児麻酔学会誌
Volume	30
Number	1
Page	58-63
Year/Month	2024 /
Article	報告
Publisher	日本小児麻酔学会
Abstract	「要旨」 小児期の術後痛による辛い経験が将来的に痛みの閾値を低下させ, 心理面にも影響を与えることが知られている. 新生児期から幼児期では患児が痛みの性状を正確に表現することができないため痛みの評価が難しい. したがって年齢や発達段階に応じた痛みの評価ツールを用いる. 小児の術後鎮痛の基本は成人と同様に多角的疼痛管理であるが, 使用可能な鎮痛薬の種類に制限が多く, 投与量の決定には体格に加えて薬物動態が考慮される. さらに区域麻酔は原則として全身麻酔下で行われ, 小児の体格が小さくかつ組織が軟らかいため誤穿刺のリスクは高い. 近年では超音波装置の性能の向上により末梢神経ブロックの安全性は高くなり多くの小児手術で行われている. また小児でも遷延性術後痛が問題となっており, 術後痛のほかに児や保護者の術前不安もリスク因子になる. そのため小児の術後痛の管理は周術期を通した対策が必要である.
Practice	臨床医学：外科系
Keywords	小児, 術後痛, 多角的疼痛管理, 末梢神経ブロック, 遷延性術後痛, children, postoperative pain, multimodal analgesia, peripheral nerve block, chronic postsurgical pain

English

Title	Fundamental approach to pediatric postoperative pain management
Subtitle	Invited Paper
Authors	Tomonari Shinozaki
Authors (kana)
Organization	Department of Anesthesiology, Miyagi Children's Hospital
Journal	Clinical Pediatric Anesthesia
Volume	30
Number	1
Page	58-63
Year/Month	2024 /
Article	Report
Publisher	Japanese Society of Pediatric Anesthesiology
Abstract	[Abstract] Accumulating evidence suggests that painful childhood experiences during the postoperative period adversely affect children's sensitivity to pain and psychological development. However, the precise evaluation of pain in newborns and young children is difficult because they are unable to express the intensity and nature of their pain to others. Hence, age-specific and developmentally appropriate assessment tools to evaluate pain in children are necessary. Multimodal analgesia is a fundamental approach in pediatric postoperative pain management. However, practitioners need to consider the limitations of the types of analgesics available for pediatric patients and the dosage of analgesics, which is determined by the patient's weight and pharmacokinetic maturity. Regional anesthesia, typically performed under general anesthesia in children, carries the risk of tissue penetration because of their smaller body sizes and softer tissues. Nevertheless, recent use of ultrasound to improve visibility has changed the delivery of peripheral nerve blocks, rendering it a safer analgesic approach for most pediatric surgeries. Chronic postsurgical pain (CPSP) can also be problematic among children. In addition to postoperative pain intensity, the risk of CPSP increases in children and parents who experience preoperative anxiety. Therefore, pediatric postoperative pain management must also address the psychological aspects of both patients and their families in the perioperative period.
Practice	Clinical surgery
Keywords	children, postoperative pain, multimodal analgesia, peripheral nerve block, chronic postsurgical pain

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