Διαφάνεια 1

. . & . . Mather L, Mackie J. The incidence of postoperative pain in children. Pain 1983; 15: 271 282 170 16 %

40 % 25 % 40 % 75 % . Anand et al. Measuring the severity of surgical stress in newborn infants. J Pediatr Surg 1988;23:297-305

R. P. Smith et al. Pain and stress in the human fetus European Journal of Obstetrics & Gynecology and Reproductive Biology 2000;92:161-165 (1) 7 22-29 . ( )

~ (2) . ~ (3)

( , C)) . ~ : , (4) ,

. (GABA, )

1. : Gold standard (>5 ) 2. 3. oo 4. o o - Wong-Baker FAC)ES 1988 Wong DL, Baker C)M: Pain in children: C)omparison of assessment scales. Pediatric Nursing 1988;14:9-17

VAS: C)oloured Analogue Scale The greatest pain imaginable No pain Neonatal Facial Coding System (NFCS) FLACC (>1 ) Craig K et al. The facial expression of pain.

In: Turk DC, Melzack R, eds. Handbook of Pain Assessment. 2nd ed. New York, NY: Guilford Press, 2001:153-169 FLAC)C) The Non-communicating C)hildren's Pain C)hecklistNC)C)PC) The Non-communicating C)hildren's Pain C)hecklistPostoperative version NC)C)PC)-PV Breau LM, Finley GA, McGrath PJ, Camfield CS. Validation of the Non-communicating Children's Pain

Checklist-Postoperative Version. Anesthesiology 2002;96:528-535 NC)C)PC)-PV ( ) , , ( )

, , , , , , , , , , ,

, , , , , , , , , , ,

, , -

24-72

>3 5-10 mg/kg 6-8 po 30 mg/kg/24 po 7.5 mg/kg 12 po 15 mg/kg/24 po >6 1 mg/kg 8 po 3 mg/kg/24 po Good Practice in Postoperative and Procedural Pain. Assoc. Ped. Anaesth. of

G.B and Ireland, 2012 ? ? C)OX-2

? ? 10-30 g/kg/h 5-10 g/kg/h: 9.0 3.4 6.5 2.8 2.0 1.8

2.2 0.7 8.1 3.2 ml/min/kg 0.5-1mg/kg 6 po, pr J De Lima, KB Carmo. Practical pain management in the neonate. Best Pract Res Clin Anesth 2010;24:291-307 Good Practice in Postoperative and Procedural Pain. Assoc. Ped. Anaesth. of G.B and Ireland, 2012

0.5- 1 mg/kg po,pr 3 6 mg/kg/24 (+ , ) N 0,2- 0,3 mg/kg iv 4 1,2 1,8 mg/kg/24

1-2 mg/kg iv 4-6 200-400 gr/kg iv 10-40 gr/kg/h PC)A 10-20 gr/kg 5-10 min 0-4 gr/kg/h 200-500 gr/kg 3-4 po

Monitoring !!! Naloxone 2-4g/kg iv 10g/kg lower alarm limit = 94% SpO2 .

RR<20/min <12/min ! 0= 1= 2= 3= R.A. Lawson. Opioid techniques in: Acute Paediatric Pain Management: a practical guide. N.S. Morton Editor. W.B.Saunders 1st Edition 1998,pp 127-168

3 1 .- . 6 mm10-12 mm Levobupivacaine - Ropivacaine Ropivacaine

0.1-0.2% 0.5-2 ml/kg : 4-6 . Ropivacaine-Levobupivacaine 1 mg/ml :0.2-0.4mg/kg/h Good Practice in Postoperative and Procedural Pain. Assoc. Ped. Anaesth. of G.B and Irel. 2012

Ropivacaine 2 mg/kg Levobupivacaine 1 mg/kg 30 g/kg 1-4 g/kg/h 50%

0.5-1 g/kg 0.3-0.8 g/kg/h J. Desparmet et al. C)entral blocks in children. In: Pain in infants, children and adolescents. Edited by N. Schlechter et al. Lippincott Williams & Wilkins 2nd Edition 2003

Olney JW. New insights and new issues in developemental neurotoxicity. Neurotoxicology 2002;23:659-668.

M. Asermino, R.Basu, C). Vandebeek et al. Non opioid additives to local anaesthetics for caudal blockade in children: a systematic review. Paed Anaesth 2003;13:561-573. C)ousins MJ, Miller RD. Intrathecal midazolam: an ethical editorial dilemma. Anesth Analg 2004;98:1507-1508.

D.A.H. de Beer, M.L. Thomas. C)audal additives in children- solutions or problems? BJA 2003;90:487-498 P.A. Lonnqvist. Adjuncts to caudal block in children-Quo vadis? BJA 2005;95(4):431-433.

B.Dalens. Some current controversies in paediatric regional anaesthesia. C)urr Opin Anaesthesiol 2006;19:301-308 , , , ? 1- 3 g/kg 2-3 1-3

: EMLA

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