PURPOSE OF REVIEW: Poor pain management has continued to be a problem after pediatric surgery. This review examines the current situation and recent advances in the area. RECENT FINDINGS: Nonopioids such as paracetamol and NSAIDs play an increasing role as components of multimodal analgesia in children. However, studies on the safety and efficacy of many adjuvants in pediatrics are still lacking. The use of opioids is influenced understandably by safety concerns about respiratory depression, but data on its incidence are poor. The role of regional techniques in the treatment of pain after pediatric surgery is growing in line with the developments in adults; the emphasis here is more on peripheral techniques too. SUMMARY: The concept of multimodal analgesia including the use of regional analgesic techniques is governing the current developments and discussions in the area of pediatric postoperative analgesia. © 2013 Lippincott Williams & Wilkins.