Acute pain management in the neonate
This is an educational article discussing the management of mainly post-surgical pain in neonates from a group of authors based at Alder Hey Children’s Hospital in the UK. It has sections on physiology, pain assessment, non-pharmacological approaches, pharmacological approaches, and regional anaesthesia. It reads more as a report of their local practice than a review. It is useful as it provides a framework for assessment and management including dosages used for nurse-controlled analgesia programs and various regional blocks, which are not always easily accessible.
They also report on and encourage the use of PR codeine in this age group. It appears to be something they have been able to make work for them in their institution, but they present it without any data to support this practice. Either side of this is an acknowledgment of the UK’s prohibition on the use of codeine in under-12s and the challenges of morphine use in neonates.
The article could have been more comprehensive by re-iterating the pharmacokinetic differences in this age group (these are briefly covered while discussing morphine), reviewing fentanyl and a-2 agonists in more detail, and discussing management of procedural pain/skin-breaking procedures; a significant source of pain and distress in this age group and something which we contribute to as anaesthetists.
Reviewed by Dr David Sainsbury