Download 0.05 mg /kg (IV / SQ)

PHARMACOLOGIC MANAGEMENT
OF NEONATAL PAIN
Dr. ARAMESH
NEONATOLOGIST
AJUMS
GENERAL CONSIDERATION
1- Complementary Therapies
ENVIRONMENTAL
BEHAVIORAL
2- Prophylaxis vs. Pain Management
3- Gestational Maturity
4- Long-Term Complication
INTELIGENCE
MOTOR FUNCTION
BEHAVIOR
COMMONLY USED LOCAL ANESTHETIC AGENTS IN NEONATES
Local Anesthetics
Maximum Dose
Lidocaine 0.5%
5mg / kg
,
SQ
 33-37 wk PMA (> 1.8kg): 0.5 gr for 1-2 h.
Topical EMLA 5%
 > 37 wk PMA (> 2.5 kg): 1gr for 1-2 h.
COMMONLY USED ANALGESIC AGENTS IN NEONATES
ANALGESICS
INTUBATED
NON-INTUBATED
Morphine
0.05-0.15 mg /kg
(IV /SQ)
Fantanyl
1-3 ngr/ kg IV
(Over 5 min)
0.025 – 0.05 mg
/kg
(IV / SQ)
0.25- 1 ngr / kg IV
(over 5 min)
Acetaminophen
10-15 mg /kg Po/Pg
/PR
Q 6h and/or PRN
(Max. Dose : 40 mg
/kg/d)
INFUSION IN
INTUBATED
NEONATES
COMMONLY USED SEDATIVE AGENTS IN NEONATES
SEDATIVES
DRUG
DOSE
Short Term
Midazolam
0.05 – 0.1 mg/Kg IV /
Intra-nasal
Chloral
Hydrate
20-30 mg/Kg , PO / PG
Long Term
Phenobarbital
Loading : 5-15 mg/Kg
PO/PG/IV
Maintenance: 3-4 mg/Kg
ANALGESIA FOR MINIMALLY INVASIVE PROCEDEERES
Procedures
Intubated / ventilated
Non-intubated
Arterial Puncture
24% Sucrose (0.5 – 1.5 ml)
24% Sucrose(0.5 – 1.5 ml)
Veni-Puncture
24% Sucrose(0.5 – 1.5 ml)
24% Sucrose(0.5 – 1.5 ml)
Heel- Stick blood Draw
24% Sucrose(0.5 – 1.5 ml)
24% Sucrose(0.5 – 1.5 ml)
Intravenous placement
24% Sucrose(0.5 – 1.5 ml)
24% Sucrose(0.5 – 1.5 ml)
Lumbar puncture
24% Sucrose PO And morphine IV / SQ
OR Fentanyl
24% Sucrose PO And EMLA +
Lidocaine 0.5% ( If > 34 WK PMA)
Dressing change
24% Sucrose PO And
OR Fentanyl
//
ET- Suctioning
Morphine
Immunization injections
N/A
morphine IV / SQ
OR Fentanyl IV
N/A
24% sucrose OR Topical EMLA
(In> 34 WK PMA)
ANALGESIA FOR INVASIVE PROCEDURES: PRETERM & TERM
Procederes
Intuvated/ventilated
Non- intuvatid
Intubation (Emergency)
NONE
NONE
Intubation (Elective)
Fentanyl / Morphine
Fentanyl / Morphine
 1ST day
Fentanyl / Morphine
N/A
 > 1 day
Fentanyl / Morphine
N/A
Chest tube:
 Insertion
 In–Place
 Removal
Lidocaine + M / F
Fentanyl / Morphine
Fentanyl / Morphine
Lidocaine + M / F
Fentanyl / Morphine
Fentanyl / Morphine
Umbilical catheter placement
Fentanyl / Morphine
Fentanyl / Morphine
PICC
Fentanyl / Morphine
/ EMLA
Fentanyl / Morphine
M. Ventilation:
‫با تشکرازتوجه شما‬