Pediatric Analgesia - Dr. Fox

Why it Matters

• Patient Satisfaction - Pain management is a very prominent driver of patient satisfaction.
• Our Satisfaction - Caring for our patients and alleviating discomfort is part of why we got into this job. 
• Departmental Function - Patients in pain slow your department down! 

• It is often a slippery slope between being Compassionate and becoming Cruel.
• Simple strategies can help you from sliding down this sadistic hill.

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Intranasal Fentanyl

• Intranasal Fentanyl is as efficacious as IV Morphine... but doesn't require the IV.
• This means it can be started soon after initial evaluation.
• Dose = 1-2 micorgrams/kg
• Don't use more than 0.3 mL per nostril at one time.
• Use an atomizer!
• http://pedemmorsels.com/intranasal-analgesia/
  

Nitrous - It's NOt Just for Dentists!

• Nitrous works great - it gives analgesia, anxiolysis, and anesthesia.
• It is nearly the ideal sedative -- onset is rapid and offset is even more rapid.
• It has minimal side-effects - nausea and vomiting.
• Contra-indicated for patients with areas of entrapped air (ptx, bowel obstruction) and in pregnant women.
• Can really help make those minor procedures (I+D, lac repairs, Lumbar punctures) easier.  
• If the patient is giggling during your I+D, you will have a good day.
• http://pedemmorsels.com/nitrous-oxide/
  

NEonates Feel Pain too!!

• Consensus Statement for Prevention and Management of Pain in the Newborn (2001) states:
• NEONATES DO FEEL PAIN.
• NEONATES MAY HAVE GREATER SENSITIVITY TO PAIN.
• NEONATES ARE MORE SUSCEPTIBLE TO LONG TERM EFFECTS OF PAIN.
• Use LMX (or other topical lidocaine) along with oral sucrose to help manage the neonates pain during lumbar punctures!
• This will help them as well as help you be more compassionate and likely improve your success rate!
• http://pedemmorsels.com/neonatal-analgesia/