28 © Anestesia en México 2006;18(1): Review Article Enrique Hernández- Cortez MD Pediatric Anesthesiologist Chief of Anesthesiology

The treatment of pain and suffering should be a priority for all clinicians. Previous scientific research has detected inadequate treatment of pain in infants and children, though pain occurs in all societies, at every age and represents the most common symptom for which the patient seeks medical assistance. Non-opiate analgesics are frequently used as a transitional short-term analgesic, especially to treat and prevent mild to moderate pain. For severe pain these agents are combined with opiates to provide the best results. The emphasis of this review will be the pharmacological management of acute pain through the use of NSAIDs. During the last decade a broader understanding of the pathophysiological mechanisms of tissue damage and postoperative pain has provided clinicians with a rationale for balanced postoperative analgesia. Peripheral tissue damage and hypersensitization of the posterior horn of the spinal cord are probably of greater clinical significance. Non-opiate analgesics play an important role in the treatment of post-operative pain, blocking hypersensitization of the dorsal horn, and are very effective in combination with local or regional nerve block, especially in outpatient surgery. Several COX-2 inhibitors have recently been evaluated in the pediatric setting. Studies show equal efficacy with other analgesics, including non-selective NSAIDs or acetaminophen and morphine. They offer a number of advantages over NSAIDs when used in post-operative pain management, including a significant reduction in the incidence of gastrointestinal ulceration and lack of inhibition of platelet activity, consequently reducing the risk of bleeding or blood loss. Other benefits have also been uncovered, such as less impairment of bone healing and lack of bronchospasm in asthmatic patients with aspirin intolerance. Still, their role in children is limited and not well defined, as only a small number of studies have evaluated their importance in the pediatric setting. Key words: Non-steroidal anti-inflammatory analgesics, pediatric