Article first published online: 13 NOV 2013
© 2013 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Special Issue: Neonatal Anesthesia: Frontier Concepts in Theory and Practice
Volume 24, Issue 1, pages 39–48, January 2014
How to Cite
Walker, S. M. (2014), Neonatal pain. Pediatric Anesthesia, 24: 39–48. doi: 10.1111/pan.12293
- Issue published online: 14 DEC 2013
- Article first published online: 13 NOV 2013
- Manuscript Accepted: 23 SEP 2013
- British Journal of Anaesthesia/Royal College of Anaesthetists
- Medical Research Council
- regional analgesia
Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.