The Neurobiology of Pain
Postoperative pain Procedural pain Even extremely premature neonates are able to process and experience pain. Repeated painful stimuli experienced in the neonatal period have been associated with adverse longterm consequences, including poor cognitive outcomes. Neonates and infants are particularly vulnerable because of the plasticity of their nervous systems. Inhibitory descending pathways
Even extremely premature neonates are able to process and experience pain. Repeated painful stimuli experienced in the neonatal period have been associated with adverse longterm consequences, including poor cognitive outcomes. Neonates and infants are particularly vulnerable because of the plasticity of their nervous systems. Inhibitory descending pathways only develop after the ascending nociceptive pathways, which possibly, in theory, results in increased susceptibility to painful stimuli.
Postoperative pain
The type and extent of surgery are the main predictors of the severity of postoperative pain. Aspects that should be considered are the degree of tissue damage, the presence of preoperative pain, and the likely duration of pain. This will guide the choice of regional anaesthesia technique and whether catheter techniques or additives should be used. Pain is typically moderate to severe for 48–72 hours after intermediate or major surgery. However, pain can persist for longer under certain conditions, such as ileus or significant nerve injury. Surgical pain usually includes neuropathic elements, which do not respond to simple or opioid analgesia. Also, other sources of pain should be considered (e.g. vascular cannulae, nasogastric tubes, urinary catheters and chest drains).
Procedural pain
The aim of procedural pain management is to minimise physical discomfort, pain, movement and psychological disturbance, without compromising patient safety. For a comprehensive guideline on paediatric procedural sedation and analgesia, please refer to the SASA paediatric guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in children: 2021–2026.
South African Society of Anaesthesiologists (SASA) Guidelines for the Management of Acute Pain in Specific Scenarios 2022