PHARMACOLOGIC MANAGEMENT OF NEONATAL PAIN

Dr. ARAMESH

NEONATOLOGIST

AJUMS

GENERAL CONSIDERATION

1- Complementary Therapies

ENVIRONMENTAL

BEHAVIORAL

2- Prophylaxis vs. Pain Management

3- Gestational Maturity

4- Long-Term Complication

INTELIGENCE

MOTOR FUNCTION

BEHAVIOR

COMMONLY USED LOCAL ANESTHETIC AGENTS IN NEONATES

Local Anesthetics Maximum Dose

Lidocaine 0.5% 5mg / kg , SQ

Topical EMLA 5%

33-37 wk PMA (> 1.8kg): 0.5 gr for 1-2 h.

> 37 wk PMA (> 2.5 kg): 1gr for 1-2 h.

COMMONLY USED ANALGESIC AGENTS IN NEONATES

ANALGESICS INTUBATED NON-INTUBATED INFUSION IN INTUBATED NEONATES

Morphine 0.05-0.15 mg /kg (IV /SQ)

0.025 – 0.05 mg /kg

(IV / SQ)

Fantanyl 1-3 ngr/ kg IV(Over 5 min)

0.25- 1 ngr / kg IV(over 5 min)

Acetaminophen 10-15 mg /kg

Po/Pg /PR

Q 6h and/or PRN (Max. Dose : 40 mg

/kg/d)

COMMONLY USED SEDATIVE AGENTS IN NEONATES

SEDATIVES DRUG DOSE

Short Term Midazolam 0.05 – 0.1 mg/Kg IV / Intra-nasal

Chloral Hydrate

20-30 mg/Kg , PO / PG

Long Term PhenobarbitalLoading : 5-15 mg/Kg PO/PG/IVMaintenance: 3-4 mg/Kg

ANALGESIA FOR MINIMALLY INVASIVE PROCEDEERESProcedures Intubated / ventilated Non-intubated

Arterial Puncture 24% Sucrose (0.5 – 1.5 ml) 24% Sucrose(0.5 – 1.5 ml)

Veni-Puncture 24% Sucrose(0.5 – 1.5 ml) 24% Sucrose(0.5 – 1.5 ml)

Heel- Stick blood Draw 24% Sucrose(0.5 – 1.5 ml) 24% Sucrose(0.5 – 1.5 ml)

Intravenous placement 24% Sucrose(0.5 – 1.5 ml) 24% Sucrose(0.5 – 1.5 ml)

Lumbar puncture 24% Sucrose PO And morphine IV / SQ OR Fentanyl

24% Sucrose PO And EMLA + Lidocaine 0.5% ( If > 34 WK PMA)

Dressing change 24% Sucrose PO And morphine IV / SQ OR Fentanyl

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ET- Suctioning Morphine OR Fentanyl IV N/A

Immunization injectionsN/A 24% sucrose OR Topical EMLA

(In> 34 WK PMA)

ANALGESIA FOR INVASIVE PROCEDURES: PRETERM & TERMProcederes Intuvated/ventilated Non- intuvatid

Intubation (Emergency) NONE NONE

Intubation (Elective) Fentanyl / Morphine Fentanyl / Morphine

M. Ventilation: 1ST day > 1 day

Fentanyl / Morphine

Fentanyl / Morphine

N/A

N/A

Chest tube: Insertion In–Place Removal

Lidocaine + M / FFentanyl / Morphine Fentanyl / Morphine

Lidocaine + M / FFentanyl / Morphine Fentanyl / Morphine

Umbilical catheter placement Fentanyl / Morphine Fentanyl / Morphine

PICC Fentanyl / Morphine / EMLA

Fentanyl / Morphine

با تشکر از توجه شما