Analgesia for skin-breaking procedures in newborns and children: what works best?

摘要

Healthy newborns routinely experience acute pain during blood sampling for metabolic screening, injection of vitamin K or hepatitis vaccine, or circumcision. Children are similarly exposed to acute pain due to vaccination, invasive procedures or trauma. Acute pain caused by skin-breaking procedures can lead to physiologic instability and behavioural distress, and it has downstream effects on subsequent pain processing, development and stress respon-sivity. Because of these detrimental effects, reduction or prevention of pain are worthy clinical goals that are also expected by most parents.Opioids, such as fentanyl and morphine, form the mainstay of pediatric pain management, but they may not be effective against injury-induced acute pain in newborns or children. Accumulating data suggest that opioids lead to harmful side effects, tolerance and possibly altered brain development. Other analgesic and anesthetic agents also appear to increase brain cell death in animal studies, fuelling concerns about their use, particularly in newborns. Such concerns have led to the development of nonpharmacologic therapies such as sucrose, massage and kangaroo care for neonatal pain, and distraction techniques, hypnosis and cognitive-behavioural interventions for pediatric pain.