Stanford School of Medicine
Pediatric Anesthesia– In the Department of Anesthesia

Pediatric Pain Management

Epidural & Spine Analgesia

These methods provide excellent pain control for hospitalized children, with less medication than would be required if the IV route were used. An epidural or spinal catheter usually remains in place for one to five days although special techniques are available to permit catheters to remain in for longer periods of time or be permanently implanted for chronic pain management at home. Epidural medication blocks pain at the level of the spinal cord where pain information is transmitted up to the brain. This form of analgesia does not interfere with a child’s ability to walk, although there is sometimes a feeling of "numbness" involving the site of surgery or the legs. By using spinal analgesia, we are able to use doses of pain killers that are only one-tenth or even one-hundreth of the usual dose given conventionally.

PCA

Patient Controlled Analgesia allows a hospitalized child to push a button that will signal a computer controlled pump to deliver a small, preset amount of medication through the existing IV or epidural catheter, instead of receiving pain medication as an additional painful injection. This system is engineered so that the child cannot give him or herself too much medication, yet is able to adjust the level of medication to their own level of pain.

Other Pharmacological Techniques

The Pain Management Service also makes use of diagnostic and therapeutic nerve blocks, drug therapy of pain using oral analgesics of several types, as well as drug therapy of pain with analgesics administsered through the skin, tailoring the drug therapy program to each child’s medical and surgical problems. We have the ability to implant electronic medication pumps under the skin for delivery of medications at home when pain is chronic.

Recently, many drugs in categories not usually thought of as analgesics have been found to have important analgesic effects. These drugs include anticonvulsants, antidepressants, antihypertensives, and cardiac antiarrhythmics. The Pain Management Service frequently makes use of these innovations in pain management.

Non-Pharmacological Methods (Complementary, or Integrative Medicine)

The Pain Management Service also uses several non-pharmacological methods to control pain, including:

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