Research utilization: pharmacologic management of neonatal pain

Opioids, particularly morphine sulfate and fentanyl, continue to be the most commonly used agents for analgesia. Morphine provides greater sedation, and there is less of a problem with rigidity of the chest wall than with fentanyl. Morphine also has a higher level of tolerance than does fentanyl. Table 2 provides considerations for administration of morphine and fentanyl. Sedation for the relief of pain without analgesia is not acceptable. Sedation and analgesia together may be in the baby's best interest. Before any plan of care is implemented, the baby should be evaluated for need based on the amount of current respiratory support versus spontaneous respiration. There is evidence in the research literature that narcotic administration can be safely carried out in the preterm when using intravenous caffeine simultaneously to offset the risk of apnea. Others state that there really is no safe therapeutic window for narcotic administration in the preterm infant, yet the benefits outweigh the respiratory depressant effect. The complication of respiratory depression can be readily dealt with through the administration of neonatal Narcan via the intramuscular, intratracheal, or intravenous routes.