Procedural Sedation and Analgesia in Children

Abstract

Procedural sedation and analgesia (PSA) can be defined as the use of sedative, analgesic, or dissociative drugs in order to provide anxiolysis, analgesia, sedation, and motor control during painful or unpleasant diagnostic and therapeutic procedures.

In conclusion, the ideal approach to pediatric sedation should be based on the concept of multimodal pain management. This is unfortunately not always possible. For painful procedures performed under sedation outside the operating room, an aggressive perioperative analgesic and sedative approach that provides safe effective analgesia, patient comfort, and sedation while causing minimal side effects is needed. In addition, postoperative analgesia is crucial and can be achieved with a multimodal approach, which may incorporate the use of opioids. Opioids, used with discretion, play a crucial role in polypharmacy for painful procedures. It is anticipated that non-opioid analgesic drugs will assume a future key role as synergists for painful procedures outside the operating room.

Although the management of postoperative pain poses some unique challenges for the practitioner, an important reason for suboptimal pain management is the inadequate or improper application of available information and analgesic therapies. Multimodal analgesia techniques, including regional analgesic techniques, acetaminophen, nonspecific NSAIDs or COX-2–specific inhibitors, and opioids, have become standard practice. The choice of analgesic combinations should depend not only on their analgesic efficacy but also on the side effect profile of these combinations. Thus, even if a certain analgesic regimen provides superior pain relief, it may not be clinically beneficial if it is also associated with more adverse events.