Hi all!

We are updating our protocols on analgesia in preterm infants and we would like to know if in your services you use routine analgesia in ventilated preterm infants ,from the first days, and what is/are your preferences.

thanks in advance 

 



you are welcome , waiting  eagerly.

 

We do not routinely provide analgesia in intubated preterm neonates, but when we do it almost exclusively an opiate (fentanyl). Many are extubated early in their course and there is concern that having an opiate onboard will complicate extubation and/or lead to reintubation for 'failure'.  Our most common indication for opiate analgesia is actually to provide sedation in the event that this is felt to further the goals of mechanical ventilation.  I don't have our unit's numbers on this handy, but my sense is that most of this is actually provided when babies are on HF jet vent and we need them to not over breath the jet.

There is an extensive article by AAP on analgesia in newborns available in their website. All the recommendations are given there. Routine sedation is not warranted in ventilated neonates & is associated with bad outcomes (Ref- A metaanalysis which includes NEOPAIN study). An infant fighting the ventilator is most likely due to inadequate ventilation & sedation would mask away these signs & further worsen gas exchange. Rather adjusting the ventilator settings is a better way of dealing with it. Finally if you do plan to sedate, always avoid  midazolam & prefer fentanyl as first choice.

Thanks for your answers, we will update our protocols

Nice topic

neonatal pain policy.pdf

On 5/24/2018 at 8:08 PM, danielirra said:

Thanks for your answers, we will update our protocols

@danielirra Thank you for opening this topic, It would be nice to know what you reached in your unit`s updated protocol when it is completed.