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- Page navigation anchor for RE: Pain management in children needing laceration repairRE: Pain management in children needing laceration repair
I commend the authors for an excellent review of the technical and pharmacologic aspects of wound anaesthesia in children. But I feel strongly that this misses what is arguably the far more important aspect of the impact on the child. The fundamental basis of management - one far too often ignored - is a profound respect for the autonomy of the child themselves. I worked for a number of years in the ED of a pediatric referral centre, during which I will have sutured literally thousands of lacerations. In toddlers one is indeed reduced to the use of topical or injected anaesthetics, but even here much can be done to minimise the long term psychologic impact. The use of a 30-gauge needle, injecting very slowly, first dribbling anaesthetic into the wound, and going in through the wound edges, (below the superficial nerve endings), permits a virtually painless introduction of the agent and avoids the memory of an "assault" by a gang of white-coated adults.( Parenthetically, I never "bundled" a single child, nor did I ever perceive a need to do so. And I routinely removed my white coat before entering the room so as to remove the unfortunate associations).
But where it gets much more interesting is once the child reaches 2 or 3 years old, at which time a profound respect for their growing autonomy permits both their active cooperation, and the harnessing of their own innate abilities to manage their pain. My approach here was two-fold: First of...
Show MoreCompeting Interests: None declared.