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Systemic opioid regimens for postoperative pain in neonates
Mari Kinoshita1,2, Israel Junior Borges do Nascimento3,4, Lea Styrmisdóttir5
1Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
The Cochrane Database of Systematic Reviews
|January 16, 2023
Summary
Systemic opioid regimens for postoperative pain in neonates lack clear evidence for effectiveness and safety. Current research is limited, with uncertain benefits of continuous infusion over bolus administration for pain management in newborns.
Area of Science:
- Neonatal care
- Pain management
- Pharmacology
Background:
- Postoperative pain in neonates is a significant clinical challenge.
- Systemic opioid regimens are used but optimal choices remain unclear.
- Evidence for the safest and most effective neonatal pain management is lacking.
Purpose of the Study:
- To evaluate systemic opioid regimens for postoperative pain in neonates.
- To assess effects on mortality, pain, and neurodevelopmental disability.
- To compare different opioid administration methods (dose, route, infusion vs. bolus, scheduled vs. PRN).
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and quasi-randomized trials.
- Searches conducted in Cochrane CENTRAL, PubMed, and CINAHL up to June 2022.
- Meta-analysis stratified by intervention type, using fixed-effect models and GRADEpro for evidence quality.
Main Results:
- Seven RCTs (504 infants) were included; no studies compared different doses or routes.
- Continuous infusion vs. bolus administration showed unclear effectiveness for pain relief (very low certainty evidence).
- No studies reported on mortality, neurodevelopmental disability, or other key outcomes.
Conclusions:
- Limited evidence exists comparing continuous opioid infusion to intermittent boluses in neonates.
- Uncertainty remains regarding the superiority of continuous infusion for neonatal pain management.
- Further research is needed to address mortality and neurodevelopmental outcomes in neonates receiving opioids.
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