Pharmacological pain management approach for children in the emergency settings: a systematic review

Background: In emergency settings, prompt and effective pain management is crucial for alleviating distress and ensuring the well-being of pediatric patients. The pharmacological approach plays a central role in managing acute pain in children, but selecting the appropriate medications requires careful consideration of factors such as age, weight, medical history, and the urgency of the situation. Methods: This systematic review aims to comprehensively evaluate the efficacy, safety, and optimal use of pharmacological pain management approaches for children in emergency settings. A comprehensive search across electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library was performed. Studies involving pediatric populations (aged 0–16 years) seeking pain management in emergency departments or urgent care settings due to various medical conditions, injuries, or procedures, reporting the utilization of pharmacological interventions were considered only. The quality of the included studies was assessed using the Cochrane Risk of Bias assessment tool to evaluate the methodological quality and risk of bias in randomized controlled trials, while for observational/cohort studies, the Newcastle-Ottawa Scale was utilized to assess the quality and potential biases. Results: The final inclusion incorporated a total of 13 studies published between 2014 and 2024. Diverse pharmaceutical agents, single or in combination, were used through sublingual and intravenous routes for the management of pain among children. These pain management interventions generally led to reduced pain scores; however, the incidence of adverse events varied among studies, highlighting the importance of balancing efficacy with safety in pediatric pain management protocols. Conclusion: Despite the safety and effectiveness of these pharmacological interventions, it is crucial to acknowledge the potential risks of adverse effects linked to certain pharmaceutical agents. This emphasizes the importance of conducting future clinical research in this field, particularly randomized trials and cohort studies, to gather evidence-based data that can contribute to the creation of extremely safe therapeutic protocols for this susceptible group.