Postoperative analgesia in children: How to manage it and according to what?

Postoperative pain management should be prepared during the preoperative visit, based on the usual intensity and duration of pain following the foreseen procedure, child's preoperative status, and after obtaining parental informed consent. It should be started during surgery. For in-hospital patients, the administration of analgesics should be based on a protocol written with the whole team and including precise orders to deal with insufficient pain relief, side effects or complications. Moreover, the parents should be actively involved in their child's care. In day case surgery, communication with the parents regarding pain assessment and administration of painkillers is of paramount importance to avoid under treatment of pain as well as complications. A phone call at home the day after surgery is very useful to evaluate how the parents manage their child's recovery and to help if needed. Wherever postoperative pain is managed, its efficiency should be carefully evaluated using a quality improvement strategy. This is an energy- and time-consuming process that requires leadership, team spirit and institutional support to achieve its goals.