Dear Colleagues,

I would like to know your experience in such case:

We have a baby 30 wk GA with esophageal atresia and tracheoesophageal fistula. he had severe RDS, received 3 doses of surfactant, and large PDA.

He developed gastric perforation on day 3 of life. Emergency operation was performed. Postoperatively, he was with chest tube. he was hypotensive, unstable with DIC picture. We could not start fentanyl or morphine infusion at that stage.

My question is: what is the best way to mange pain in such cases?

Regards

According to my experience, pain may also contribute to cardiovascular instability.

Depending on the severity of the hypotension, we may still use a low dose of morphine-infusion, together with intravenous paracetamol.

Ketamine may be an option as well, although I have no personal experience using that.

Soory because is perhaps to later to give you my opinion but i will do it.

if cardiovascular instability is controlled, we use generally morphinic product (morphine, fentanyl...) or nabulphine at analgesic doses. paracetamol is also a good choice after VitK1 supplementation. we do not use Ketamine in preterm because there is not information regarding pharmacocinetics and pharmacodynamic and it is not recommended, hemodynamic instability is also another contre-indication for using it.