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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
|April 5, 2023
Summary
Systemic opioid regimens for postoperative pain in neonates lack clear evidence of effectiveness. Continuous infusion versus bolus administration shows uncertain benefits for pain management, with no data on mortality or neurodevelopmental outcomes.
Area of Science:
- Neonatal surgery
- Pain management
- Pharmacology
Background:
- Postoperative pain management in neonates is a significant clinical challenge.
- Systemic opioid regimens are widely used but optimal choices remain unclear.
- Evidence on the safest and most effective regimens is limited.
Purpose of the Study:
- To evaluate systemic opioid analgesic regimens for postoperative pain in neonates.
- To assess effects on mortality, pain, and neurodevelopmental disability.
- To compare different opioid doses, routes, and administration schedules.
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 (continuous vs. bolus infusion, as needed vs. scheduled).
Main Results:
- Seven RCTs involving 504 infants were included.
- No studies compared different opioid doses or routes.
- Continuous opioid infusion versus bolus administration showed unclear effectiveness for pain relief (very low certainty evidence).
- No studies reported on mortality, neurodevelopmental disability, or cognitive outcomes.
Conclusions:
- Limited evidence exists for continuous versus intermittent opioid infusions in neonates.
- Uncertainty remains regarding the efficacy of continuous opioid infusion for pain reduction.
- Crucial outcomes like mortality and neurodevelopmental disability were not reported in the included studies.
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