Paeds Vivas · pain-palliative-and-end-of-life-care
Acute nociceptive pain management — branching viva
A branching viva following one postoperative child through the stepwise, multimodal management of acute nociceptive pain: the scored pain assessment, the WHO two-step ladder adapted for children, the scheduled paracetamol and ibuprofen foundation, the titrated morphine by patient-controlled analgesia with sedation-score monitoring, and the recognition and naloxone response to opioid-induced respiratory depression.
On this page
Study tools
Target exams
RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
A ten-year-old weighing 34 kg is admitted overnight after emergency orthopaedic surgery for a femoral fracture, with a regional block in situ. The examiner releases information in stages. The candidate must score the pain, build the multimodal foundation up the WHO two-step ladder, state the morphine intravenous dose and the patient-controlled analgesia parameters, describe the sedation-score monitoring, recognise opioid-induced respiratory depression, and give the naloxone response titrated to the respiratory rate.
References6ShowHide
- [1]Olejnik L, Lima JP, Sadeghirad B, et al. Pharmacologic Management of Acute Pain in Children: A Systematic Review and Network Meta-Analysis JAMA Pediatr, 2025.PMID 39899301
- [8]Krauss BS, Calligaris L, Green SM, Barbi E Current concepts in management of pain in children in the emergency department Lancet, 2016.PMID 26095580
- [9]Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines for Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients Pediatr Crit Care Med, 2022.PMID 35119438
- [10]Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment Paediatr Anaesth, 2006.PMID 16490089
- [11]Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists J Pain, 2016.PMID 26827847
- [12]Dumbarton TC Regional anesthesia in complex pediatric patients: advances in opioid-sparing analgesia Can J Anaesth, 2024.PMID 37884770