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Question&Answer in NB
Pain Management in the Neonate
Professor
Mohammad H. Soltanzadeh , MD,ID
Professor of Pediatrics, Shaheed Beheshti
University
Of Medical Sciences , Tehran ,
IRAN
Question 1
An obstetrician is about to do a circumcision
without using analgesia .
When you question this practice , he replies
that neonates cannot perceive pain.
Is this correct ?
Answer
He is not correct.
Question2
When does pain perception develop in the human
fetus ?
Answer
Cutaneous sensory receptors 1st appear in
the perioral area during the 8wks of gestation
They are present in all cutaneous & mucus
surfaces by the 20wks of gestation
Question3
Are neonate less sensitive to pain than older
children or adults ?
Answer
No ! Developmentally regulated processes &
behavioral reflexes suggest that pain thresholds increase
progressively during late gestation & in the postnatal period.
Preterm neonates have much greater
sensitivity to pain than term neonates .
They manifest prolonged hyperalgesia after
tissue injury.
Question4
What kind of painful experiences are neonates
exposed to in the NICU ?
Answer
Neonates admitted to a modern-day NICU are
often exposed to pain or noxious stimulation from a variety of
sources.
These include postoperative pain resulting from
surgery to repair a hernia or to ligate a PDA .
Acute pain caused by circumcision.
Repeated heel sticks.
Venipunctures .
Tracheal suctioning
LP
Chest tubes
Prolonged or chronic pain from :NEC
Meningitis ,birth trauma, or ventilation
Even routine care such as : Diaper changes
, daily weights , removal of adhesive tape ,burns from
transcutaneous probes, rectal stimulation
Key points
pain management in neonates
All neonates feel pain& one must effectively
deal with the potential for pain during any procedure performed
during the neonatal period.
Premature infants have a greater sensitivity to
pain than term infants.
Although children may not directly recall
painful experiences from the NICU stay , they may demonstrate
altered behavioral states from painful experiences that were not
well managed.
Morphine & fentanyl appear to be equally
effective for pain relief in neonates & appear to have similar
outcomes in follow –up studies .
Methadone & some of the newer narcotic agonists
e.g. buprenorphine as well as a number of other agents , appear to
be optimal treatments for narcotic withdrawal in neonates.
Paregoric & phenobarbital are no longer drugs
of choice.
داروهای
ضد درد وآرام بخش در نوزادان
لیدوکائین 5/ تا 1 درصد زیرجلدی 5
میلی گرم پر کیلو
کرم EMLA2-5
درصد 33-37 هفته 5/ گرم برای 1-2 ساعت وبعد پاک شود
بیش از 37 هفته 1 گرم برای 1-2 ساعت
وسپس پاک شود
ضد درد در اعمال تهاجمی
شریانی ووریدی : سوکروز 20 درصد5/1 -3 سی
سی پر کیلو اورال
از پاشنه پا ورگ گیری : 5/1 -3 سی سی پر
کیلو اورال
LP:
سوکروز 20 درصد 5/1 -3 سی سی پرکیلو
اورال
سولفات مرفین 05/-15/ میلی گرم پرکیلو
وریدی یا زیر جلد
فنتانیل2-3 میکروگرم پر کیلووریدی
EMLA
یا لیدوکائین 5/ درصد
تعویض پانسمان:
سوکروز 20 در صد 5/1-3 سی سی پر کیلو
اورال
سولفات مرفین 05/-025/میلی گرم پر گیلو
وریدی
فنتانیل 25/ -1 میکروگرم پر کیلو وریدی
ساکشن لوله تراشه :
سولفات مرفین یا فنتانیل
واکسیناسیون
سوکروز 20 درصد 5/1 – 3 سی سی پر کیلو
اورال | 
