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Enhanced Recovery After Surgery (ERAS) consensus recommendations for opioid-minimising pharmacological neonatal pain

Mercedes Pilkington1,2, Brandon Pentz3, Kristin Short4

  • 1Department of Surgery, Division of Pediatric General and Thoracic Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, Canada mpilkington@ariadnelabs.org.

BMJ Paediatrics Open
|October 9, 2024
PubMed

Insights

Evidence-based guidelines recommend using regular acetaminophen and considering locoregional analgesia for neonatal pain management. These strategies aim to minimize opioid use in neonates undergoing surgery, ensuring better pain control with fewer side effects.

Area of Science:

  • Pediatric Anesthesiology
  • Neonatal Surgery
  • Pain Management

Background:

  • Enhanced Recovery After Surgery (ERAS) guidelines are established for pediatric and neonatal care.
  • A critical need exists for evidence-based recommendations on managing neonatal perioperative pain.
  • Optimizing analgesia while minimizing adverse effects is paramount in neonatal surgical care.

Purpose of the Study:

  • To develop consensus recommendations for managing neonatal pain perioperatively.
  • To establish evidence-based strategies for opioid-sparing pain management in neonates.
  • To guide the pharmacologic management of pain in neonates undergoing surgery.

Main Methods:

  • A modified Delphi consensus process was employed by an international guideline development committee.
  • Systematic literature review and critical appraisal of studies on non-opioid and locoregional analgesia.
  • Recommendations were assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework.

Main Results:

  • The study population included neonates over 32 weeks gestational age within 30 days of life.
  • Two key recommendations emerged: regular use of acetaminophen and consideration of locoregional analgesia.
  • Moderate quality evidence supports these recommendations; insufficient evidence exists for other non-opioid adjuncts.

Conclusions:

  • Evidence-based, ERAS-driven recommendations were developed to reduce opioid exposure in neonates.
  • Further research is necessary to refine multimodal pain management strategies for this population.
  • The guidelines aim to improve pain control and minimize side effects in neonatal surgical patients.
Abstract

Keywords:
AnalgesiaNeonatologyPain

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