Hazards of pentazocine for neonatal analgesia: a single-centre experience over 10 years

In developing countries, neonatal analgesia for surgical procedures is a major challenge where postoperative care is inadequate.

To report experience of pentazocine for neonatal surgery in a Nigerian tertiary hospital.

A retrospective study of surgical neonates who received pentazocine at the University of Benin Teaching Hospital in Benin City between January 1998 and December 2007.

During the period, 2590 paediatric operations were performed including 368 (14.2%) neonates, 49 (13.3%) of whom had pentazocine. The other neonates received a variety of analgesics. Of 56 neonates who developed respiratory depression, 40 (71.4%) had pentazocine (p<0.0001). Fifteen (30.6%) neonates aged between 9 hours and 28 days [mean (SD) 12 (1.2) days] died between 1 and 36 hours following 8-hourly administration of 0.5 mg/kg pentazocine. In older children who had pentazocine, over-sedation was also a problem but there were no deaths. Deaths in neonates were mainly owing to persistent respiratory depression which was compounded by the unavailability of a paediatric ventilator. However, many neonates responded to naloxone. All neonates who died had an autopsy and no lesion was found which could have compromised respiratory function.

The use of pentazocine in neonates was associated with high morbidity and mortality. Caution is required when using pentazocine for neonatal analgesia where post-operative respiratory support is insufficient.