Elsevier

Journal of Pediatric Surgery

Volume 31, Issue 12, December 1996, Pages 1616-1623
Journal of Pediatric Surgery

Comparison of continuous infusion of fentanyl to bolus dosing in neonates after surgery

https://doi.org/10.1016/S0022-3468(96)90033-0Get rights and content

Abstract

Objective: Concern about respiratory depression may lead to underuse of postoperative narcotic analgesia in neonates. The authors compared continuous infusion of fentanyl with bolus dosing in infants after surgery to determine whether continuous infusion is associated with less respiratory depression. Study Design: In the first phase of the study, 16 patients were randomly assigned to receive fentanyl by continuous infusion (C) or bolus dosing every 2 hours (B) in a double-blinded trial. Respiratory events were recorded. An observational pain score and saliva for cortisol concentration were obtained 2, 8, and 24 hours after beginning treatment to compare efficacy of pain control. In the second phase, 20 additional patients received fentanyl by continuous infusion in an unblinded fashion, with the same data collection, to more accurately determine the incidence of respiratory events. Results: In phase 1, apnea occurred in eight of nine B patients (89%) compared with one of seven C patients (14%; P < .009), prompting termination of the randomized trial. The incidence of apnea or significant respiratory depression in the next 20 patients (phase 2) who received fentanyl by continuous infusion was 25% (5 of 20; P < .01 v B). Episodes of apnea in B patients required significantly more intervention than episodes in C patients (P < .01). However, in phase 2, more patients remained intubated and ventilated than in phase 1. Pain scores and salivary cortisol concentrations decreased over the 24-hour study period and were similar in B and C patients during both phases of the study. Conclusion: Continuous infusion of fentanyl at the doses studied is associated with pain control similar to that with bolus dosing at regular intervals. Although episodes of respiratory depression were less severe and less frequent for C patients, there may be an increased need for ventilator support with continuous infusion of fentanyl to achieve acceptable pain control. Providing adequate pain control to neonates in the immediate postoperative period remains a challenge.

References (43)

  • G Purcell-Jones et al.

    The use of opiods in neonates. A retrospective study of 933 cases

    Anaesthesia

    (1987)
  • KJS Anand et al.

    Pain and its effects in the human neonate and fetus

    N Engl J Med

    (1987)
  • AB Fletcher

    Pain in the neonate

    N Engl J Med

    (1987)
  • PS Williamson et al.

    Physiologic stress reduction by a local anesthetic during newborn circumcision

    Pediatrics

    (1983)
  • CC Johnson et al.

    Acute pain response in infants: A multidimensional description

    Pain

    (1986)
  • MR Gunnar et al.

    Adrenocortical activity and behavioral distress in human newborns

    Dev Psychobiol

    (1988)
  • MR Gunnar et al.

    Cortisol and behavioral responses to repeated stressors in the human newborn

    Dev Psychobiol

    (1992)
  • G Barrier et al.

    Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system

    Intensive Care Med

    (1989)
  • LM Broadman et al.

    Testing the validity of an objective pain scale for infants and children

  • KJS Anand et al.

    Hormonal-metabolic stress responses in neonates undergoing cardiac surgery

    Anesthesiology

    (1990)
  • KJS Anand et al.

    Halothane-morphine compared with high-dose sufentanil for anesthesia and post operative analgesia in neonatal cardiac surgery

    N Engl J Med

    (1992)
  • Cited by (0)

    Supported by Grant No. M01 RR00069, General Clinical Research Centers Program, National Center for Research Resources, NIH.

    View full text