Morphine Does Not Provide Adequate Analgesia for Acute Procedural Pain Among Preterm Neonates

Abstract

Despite its routine use in the NICU, morphine given as a loading dose followed by continuous intravenous infusions does not appear to provide adequate analgesia for the acute pain caused by invasive procedures among ventilated preterm neonates.

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

“…This might be explained, partly, by the use of morphine neither improving neonatal neurodevelopmental outcomes 39 nor providing adequate analgesia for procedural pain in preterm neonates given TV. 40 Health providers also fear that opioid use could prolong the length of TV. Nonetheless, we should keep in mind that alleviation of neonatal pain and suff ering is a suffi cient reason to use adequate analgesics, including opioids, in this population.…”

Anaesthesia for the laser treatment of neonates with retinopathy of prematurity

“…9 Analgesics such as fentanyl and morphine when given alone are also not the answer, as even in large doses they do not completely obtund the autonomic response to noxious stimuli, but may result in prolonged respiratory depression. [10][11][12] In the case of fentanyl, rapid large boluses can also result in sudden profound chest wall rigidity, which results in an inability to ventilate. Thus, a balanced anaesthetic using sedation, analgesia, and muscle relaxation in lower doses provides optimal conditions for treatment but with reduced side effects.…”

The development of potentially better practices to support the neurodevelopment of infants in the NICU

“…261,262 In addition, continuous narcotic drips have little or no measurable impact on pain mitigation. [263][264][265] Fentanyl has been associated with hypothermia, chest wall rigidity, 266 and both morphine and fentanyl lead to increased length of stay associated with narcotic dependence. 267 Morphine has been associated with hypotension 268 and prolonged ventilatory support.…”