Pain management in pediatric traumatology and orthopedics: analysis of current clinical guidelines

Analgesia in pediatric traumatology and orthopedics is one of the key challenges. The choice of method should be regulated, including by approved clinical guidelines. This article analyzes current Russian clinical guidelines as of 2026. An information search was performed in the full texts of the guidelines using the keywords обезболивание (pain management), анальгезия (analgesia), анальгетики (analgesics), нестероидные противовоспалительные средства (nonsteroidal anti-inflammatory drugs), наркотические анальгетики (opioid analgesics), and шкала (scale). The search results were summarized for subsequent analysis. At the time of the study, 36 clinical guidelines directly related to pediatric traumatology and orthopedics were registered. In 20 guidelines, pain management for musculoskeletal injuries is recommended both in the preoperative and postoperative periods. In musculoskeletal disorders, pain management is considered either separately in the preoperative and postoperative periods or in both periods. Among pain assessment scales, the visual analog scale was mentioned most frequently (7 guidelines). Opioid analgesics were proposed for use in 19 clinical guidelines, paracetamol in 32, and ibuprofen in 31. Thirty-five guidelines included references to other analgesics (most often nonsteroidal anti-inflammatory drugs without specification of a particular agent). Paracetamol and ibuprofen were the most frequently mentioned drugs in clinical guidelines, recommended for pain management both during the acute phase of injury and following surgery. Taking into account the different profiles of these drugs and their different pharmacodynamic and pharmacokinetic properties, a combined dosage form including both agents was developed. The rapid onset of paracetamol together with the prolonged action of ibuprofen makes their combination effective for fast and sustained analgesic effect.