儿科疼痛管理是多模式的，包括非药物治疗和药物治疗方法。阿片类药物，尤其是吗啡和羟吗啡酮，常用于治疗中度至重度疼痛。本综述的目标是描述两种药物的药理特性，总结其各自适应证的最新证据，并促进其在儿科中的安全使用。吗啡是儿童中最研究的阿片类药物，已被证明安全有效。吗啡和羟吗啡酮可用于急性疼痛管理，但通常不用于慢性非肿瘤疼痛治疗。目前的证据表明，这两种阿片类药物的疗效和不良反应特点相似。羟吗啡酮在新生儿中尚未进行研究，但在一些中心，它已被用于某些患者代替吗啡。在姑息治疗中，阿片类药物常常是指征，其益处不仅限于镇痛，还包括用于治疗严重神经功能障碍患儿的中枢神经病理性疼痛和垂死病人的呼吸窘迫。长期以来认为精细调整剂量的阿片类药物会加速死亡的观念应予舍弃，因为有强有力的证据表明相反。在当前阿片类药物危机下，应该提倡负责任的阿片类药物使用，包括将阿片类药物的处方限制在患者预期需求范围内，优化多模式镇痛计划，包括使用非药物措施和非阿片类药物，并向患者和家属提供有关安全存储和处置的信息。需要更多的数据来更好地指导儿童中吗啡和羟吗啡酮的使用。

The management of pain in pediatrics is multimodal and includes non-pharmacologic and pharmacologic approaches. Opioids, and particularly morphine and hydromorphone, are frequently used to treat moderate-to-severe pain. The goals of this review are to describe the pharmacological characteristics of both drugs, to cover the latest evidence of their respective indications, and to promote their safe use in pediatrics. Morphine is the most studied opioid in children and is known to be safe and effective. Morphine and hydromorphone can be used to manage acute pain and are usually avoided when treating chronic non-cancer pain. Current evidence suggests that both opioids have a similar efficacy and adverse effect profile. Hydromorphone has not been studied in neonates but in some centers, it has been used instead of morphine for certain patients. In palliative care, the use of opioids is often indicated and their benefits extend beyond analgesia; indications include treatment of central neuropathic pain in children with severe neurologic impairment and treatment of respiratory distress in the imminently dying patients. The longstanding belief that the use of well-titrated opioids hastens death should be abandoned as robust evidence has shown the opposite. With the current opioid crisis, a responsible use of opioids should be promoted, including limiting the opioid prescription to the patient's anticipated needs, optimizing a multimodal analgesic plan including the use of non-pharmacological measures and non-opioid medications, and providing information on safe storage and disposal to patients and families. More data is needed to better guide the use of morphine and hydromorphone in children.