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Pediatric Orthopedic Surgery 

Pediatric Orthopedic Surgery
Pediatric Orthopedic Surgery
Acute Pain Medicine

Karen Boretskty


This chapter discusses the importance of using a comprehensive multimodal approach to analgesia following pediatric orthopedic surgery. Prior to opioid use, nonopioid adjuncts such as acetaminophen and short-course nonsteroidal anti-inflammatory use is preferred. Because breakthrough pain is common, targeted opioid therapy is often appropriate, and dosing guidelines are described in the chapter. Codeine is not recommended in the pediatric population. Following surgery, the use of peripheral regional anesthesia and perineural infusions has been shown to provide superior analgesia and opioid-sparing characteristics. While compartment syndrome is a concern in the pediatric population, few data exist to suggest peripheral regional anesthesia delays diagnosis. Pediatric patients with the appropriate amount of support may be discharged home with a perineural catheter. Additional postdischarge nonopioid analgesics should be encouraged, and a short course of opioid therapy may be provided if needed.

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