Pediatric Pain Service

When we are on call, we cover the pediatric pain service. We also receive some lectures by the pain attendings, and many of them work in the operating room as well. At first, I was surprised there was such a thing as the pediatric pain service. How many kids have chronic pain? What kinds of cases did they manage?  But I soon saw that the mix was not so different than the adult pain service. A subset of patients have epidural or peripheral nerve catheters coming out of the operating room. Whether a TAP block for an abdominal surgery or a thoracic epidural for a lung resection, these patients needed management of the catheters postoperatively. A few patients had chronic pain from ongoing diseases. Many inflammatory bowel diseases hit teenagers and those who have had multiple surgeries develop a high pain tolerance and constant discomfort. The hardest cases for me to deal with were unfortunate children with metastatic cancer. Although rare, Stanford's pediatric oncologists see a high proportion of patients because of their expertise. Rarely, patients have true pain syndromes like complex regional pain syndrome. The most unusual cases, I think, are cases of opiate weaning for newborns whose mothers used chronic opiates or heroin. With a pretty good mix of cases, I learned quite a bit and reinforced my understanding of pain pathways and multimodal intervention techniques.