Analgesia for the Pediatric Trauma Patient: Primum Non Nocere?

The acutely injured child poses unique clinical challenges in many respects. Our understanding of these unique characteristic differences and ability to care for pediatric trauma patients has greatly improved over recent decades; however, one area in pediatric trauma care continues to suffer from relative neglect in research and shows few signs of improvement in clinical practice: analgesia. Studies of analgesia practices continue to describe pervasive undertreatment of pain in the pediatric trauma patient. A growing body of evidence suggests that poorly controlled acute pain (oligoanalgesia) not only causes suffering but may lead to both immediate complications that worsen outcomes as well as debilitating chronic pain syndromes that are often refractory to available treatments. This article will provide a review of pain in injured children with respect to its pathophysiology, clinical ramifications, and patterns of analgesia practices. Impediments to analgesia are examined regarding multiple providers of care for the acutely injured child including prehospital personnel, nurses, and physicians. Finally, the article will provide analgesia recommendations with an approach to pain relief and sedation for the injured pediatric patient.