Pain: Postoperative Analgesia in Infants and Neonates

textabstractPain affects almost everyone at some point in his or her life. A definition drawn up by the International Association for the Study of Pain (IASP) has it that pain is always subjective This would seem to imply that the way in which pain is perceived varies from person to person and may also be influenced by the setting and previous experiences. The same definition states that “inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment”. This truth has a bearing on neonates and children with profound cognitive impairment, who are not able to verbally express their pain, anxiety or other sources of distress. Therefore caregivers in the hospital setting need to find other ways to recognize pain. Early recognition is important because pain requires prompt and adequate treatment, also to prevent possible long-term sequelae. Stress hormone levels have been studied in premature neonates who underwent surgery without perioperative analgesia; levels of cortisol, aldosterone, and other corticosteroids were markedly increased, signifying high stress. In the intensive care unit (ICU) setting, stress and agitation resulting from pain and anxiety can lead children to accidentally remove medical devices endangering the child’s safety. Pain (and therefore stress) is a common condition on the ICU. Previous studies have shown that children in the ICU setting daily undergo many painful procedures, including IV canula insertion or removal, suctioning and heelstick. What’s more, a 2008 survey showed that 80% of these procedures are performed without analgesics