The postoperative (postop) use of analgesia and sedation (A/S) was studied prospectively in 109 NICUs, a representative sample of all U.S. NICUs1. During a 1-week period, 92 postop neonates were studied (gestation 34±5.4 wks [mean±SD], age 23.9±25.6 days, weight 2.31±0.98 kg, M:F 59%: 41%). Demographic variables, severity of surgery performed, the usage, doses, route, frequency, and side effects of A/S drugs were recorded. Actual drug use was verified from multiple sources. The SAS program was used for ANOVA, Mantel-Haenszel χ2 test and other statistical analyses, and the α error was set at <0.05 before analysis.

No significant differences occurred in the demographic variables or the surgical/non-surgical diagnoses between the 70 patients (pts) who received postop A/S and 22 pts who did not. Drugs commonly used for postop A/S were morphine (42 pts, 45.7%), fentanyl (28 pts, 30.4%), and acetaminophen (27 pts, 29.3%). Other drugs (meperidine, lorazepam, diazepam, and pentobarbital) were given to ≤5 pts and 17 pts received more than one drug. The use of postop A/S was not associated with the gestational age of pts, or NICUs with neonatology fellowship programs, written or verbal protocols for pain assessment, or verbal protocols for pain management. Ventilated pts were more likely to receive fentanyl postop (p=0.002), with trends for increased use of morphine and lorazepam. Acetaminophen was used more often in male vs. female neonates (p=0.022), and morphine was used more frequently in NICUs without written protocols for pain management (p=0.024). The surgical stress score was greater in pts without A/S (8.1±4.6 vs 7.5±2.8) as compared to those who received postop A/S (p=0.0014).

These data suggest that most neonates receive postop A/S. The doses used and pro re nata therapy may contribute to a significant burden of pain in some postop neonates. Investigation of postop analgesia protocols in neonates should receive a high priority.