Anesthesia and analgesia during and after surgery in neonates

Assessing Postoperative Pain in Neonates: A Multicenter Observational Study

“…The Newborn Drug Development Initiative mandated by the Best Pharmaceuticals for Children Act of 2003 has updated the approaches for assessment and management of neonatal pain that is associated with invasive procedures, surgical operations, or mechanical ventilation. 11,[39][40][41] Findings from this study strongly reinforce the need for greater research in the area of postoperative pain. 14 Clinical trial design must focus on preventing or managing postoperative pain as well as the pain that is associated with ongoing painful procedures in the postoperative period.…”

“…10 Current guidelines have not addressed postoperative pain management in neonates, and there is a minimal amount of published data to inform recommendations. 9,10 Although the provision of appropriate analgesia/anesthesia for surgical procedures is well accepted in principle, the management of postoperative pain in neonates remains extremely variable, 11 with wide inconsistencies in neonatal pain assessment, types of measurement tools, and pain management. To investigate further the discrepancies in neonatal pain assessment and treatment, we conducted a multicenter study of postoperative pain management in neonates who were admitted to the NICU.…”

Pediatric Drug Development in Anesthesiology: An FDA Perspective

“…For example, the Newborn Drug Development Initiative: Improving Neonatal Therapeutics workshop, sponsored by the NIH and FDA, included summary recommendations for pain control by members of the academic anesthesia community (5,6). Full-length articles on procedural pain, sedation and analgesia, perioperative pain, and study designs resulting from this effort have also been published (7)(8)(9)(10). High-caliber academic investigations, when conducted under an approved IND application, can continue to make valuable contributions to improve the spectrum and quality of therapeutics available to pediatric patients.…”

Efficacy of tramadol versus fentanyl for postoperative analgesia in neonates

“…Its administration however, is not free of adverse effects including, tolerance (especially when fentanyl is given by continuous intravenous infusion), respiratory depression, urinary retention, ileum and eventually nausea and vomiting. This profile prevents wider neonatal use of the drug because of fears that fentanyl will prolong the need of mechanical ventilation and parenteral nutrition, increasing the risk of morbidity and mortality during neonatal intensive care 1–3…”