Emergency department management of pain in children

Painful procedures are often necessary in the emergency care of children. These can be distressing for all concerned and have long-term physiological and psychological consequences. Effective management of pain and anxiety in the emergency department facilitates completion of diagnostic and therapeutic procedures and is associated with a reduction in psychological trauma, and in distress to parents and healthcare providers. Topical anaesthetics and injections of buffered lidocaine can anaesthetise lacerations for suturing. Topical creams such as lidocaine/prilocaine or tetracaine, or subcutaneous or iontophoresed lidocaine can make intravenous catheter placement almost painless. Nitrous oxide is useful when children are anxious, and analgesia or amnesia is required; effective deep sedation can be achieved with midazolam and either ketamine or fentanyl.