Quality of post-operative pain control in infants and neonates.

ABSTRACT

Objective: To date, little information has been reported regarding the quality of pain control in infants and neonates. We identified the incidence and risk factors of postoperative pain, effects of fentanyl on extubation, optimal doses of fentanyl and respiratory complications. Methods: This descriptive study was conducted in infants and neonates who underwent major surgery, by retrospective chart review. Patients who were assessed as having pain by using the Neonatal Infant Pain Scale (NIPS) >10 times in 24 hours were included. Demographic data, type of surgery, timing of extubation and NIPS, including type of analgesia and doses of fentanyl given, were recorded. Pain was defined as NIPS >4 twice in 24 hours. Risk factors which included age group, type of surgery and type of postoperative analgesia were recorded. Results: Seventy-two neonates and 68 infants, ASA I-III were enrolled. The overall incidence of pain was 26.4% (infants, 44.1%; neonate, 9.7%). The age group was the significant factor affecting pain (adjusted odd ratio=7.84, 95% CI = 3.00, 20.84, p <0.001). Among patients who were still receiving fentanyl infusion or just ceased from receiving infusion within 30 minutes, 91.2% of infants and 58.3% of neonates were able to be extubated. The median time to extubation in infants was less than in neonates (0 vs. 16 min). Optimal doses of intravenous fentanyl in neonates were commenced at 0.3 mcg.kg-1 for intermittent use and 0.3 mcg.kg-1.h-1 for infusion. Apneic episodes were found in 2 patients. Conclusion: From this study, the quality of pain control in infants was not as good as neonates.