Postoperative pain management in children

Despite considerable research and established guidelines, postoperative pain management in children remains suboptimal. This review aims to outline the significant developments in pediatric postoperative pain management over the past decade and to provide updated, evidence-based recommendations. A comprehensive literature search was conducted across major databases, followed by detailed analysis. In addition to the core strategies of systemic non-opioids, systemic opioids, and regional analgesia, two major developments have significantly affected clinical practice: the widespread implementation of Enhanced Recovery After Surgery (ERAS) protocols and the emerging research on chronic postsurgical pain (CPSP). ERAS protocols have played a crucial role by incorporating minimally invasive surgical techniques, which effectively reduce postoperative pain and accelerate recovery. A fundamental component of ERAS is the intentional minimization of opioid exposure, achieved through standardized opioid-sparing multimodal protocols and the proactive application of regional anesthesia. Concurrently, there is increasing awareness of CPSP as a significant long-term complication. Although its pathophysiology mechanisms remain incompletely understood, but research has shown a strong statistical correlation between CPSP development and both high levels of postoperative pain intensity and increased opioid consumption. This connection guides current preventive strategies, as CPSP affects up to 50% of pediatric surgical patients, with a higher prevalence after major surgeries. Consequently, optimizing acute pain management within an ERAS framework—by reducing both pain and opioid use—is hypothesized to serve as a protective measure against CPSP. Finally, effective postoperative pain management in children requires a multifaceted approach. This includes multidisciplinary collaboration, adherence to standardized, evidence-based protocols, continuous professional education, and individualized patient follow-up.