title: Strategies for preventing side effects of systemic opioid in postoperative pediatric patients.
abstract: OBJECTIVE
  Opioid is the gold standard for treating moderate-to-severe pain in pediatric patients. However, its undesirable side effects lead to unsatisfied postoperative pain management outcome (Pediatr Anesth, 17, 2007, 756). The most commonly reported opioid-related side effects are vomiting (40%), pruritus (20-60%) (Anesthesiology, 77, 1992, 162; Drugs, 67, 2007, 2323), and constipation (15-90%) (Int J Clin Pract, 61, 2007, 1181). The potential life-threatening adverse event, respiratory depression, is less common (0.0013%) (Pediatr Anesth, 20, 2010, 119). The aim of this review was to evaluate prevention strategies that have been shown to decrease opioid side effects in pediatric patients during the postoperative period.
  
  
  METHODS
  Literature searches were conducted from 1984 to February 2013. Meta-analysis, systematic review, and randomized, placebo-controlled studies were obtained from PubMed and the Cochrane Library. The medical subject heading (MeSH) terms were opioid analgesics, adverse effects, pediatrics, children, side effects, and postoperative pain.
  
  
  CONCLUSIONS
  Data from 62 studies were reviewed. The strategies that could effectively prevent and reduce opioid side effects in pediatric patients during the postoperative period included minimizing the amount of opioid consumption by a multimodal approach, opioid titration, using local anesthetic techniques and providing the specific prophylaxis for each side effect.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand.
authors.forename: Thanaporn
authors.initials: T
authors.lastname: Jitpakdee
authors.forename: Sahatsa
authors.initials: S
authors.lastname: Mandee
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D006801:Humans; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000150:complications* / Q000188:drug therapy; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control
chemical_list: D000701:Analgesics, Opioid
keywords: adverse effects; child; multimodal treatment; opioid analgesics; pain; pediatrics; postoperative