Anand K J S
Department of Pediatrics, University of Arkansas for Medical Sciences, AR 72202, USA.
J Perinatol. 2007 May;27 Suppl 1:S4-S11. doi: 10.1038/sj.jp.7211712.
Effective and consistent management of neonatal pain remains a controversial issue. Premature infants are repeatedly subjected to painful tests and procedures or suffer painful conditions when they are most vulnerable. With different mechanisms transducing various types of pain the practice of 'one-drug fits all' becomes questionable. Clinicians must use the latest non-pharmacologic and pharmacologic therapies for effective management of neonatal pain, distress, or agitation. Pharmacologic strategies for dealing with neonatal pain in the neonatal intensive care unit are described. Opioid therapy, once considered the mainstay for neonatal analgesia, may not be as effective as previously thought. Morphine infusions do not alter the neurological outcomes of preterm neonates and may not be effective against acute pain. Alternative approaches with methadone, ketamine, or local anesthetics should be considered. Clinicians must understand the contextual circumstances underlying pain in individual neonates and tailor therapy accordingly, using the most current evidence related to neonatal pain assessment and management.
新生儿疼痛的有效且一致的管理仍然是一个有争议的问题。早产儿在最脆弱的时候会反复接受痛苦的检查和操作，或者遭受疼痛性疾病。由于传导各种疼痛的机制不同，“一种药物适用于所有情况”的做法变得值得怀疑。临床医生必须使用最新的非药物和药物疗法来有效管理新生儿的疼痛、痛苦或躁动。本文描述了新生儿重症监护病房中处理新生儿疼痛的药物策略。阿片类药物疗法曾被认为是新生儿镇痛的主要方法，但可能并不像以前认为的那样有效。吗啡输注不会改变早产儿的神经学结局，可能对急性疼痛无效。应考虑使用美沙酮、氯胺酮或局部麻醉剂的替代方法。临床医生必须了解个别新生儿疼痛背后的具体情况，并据此调整治疗方案，采用与新生儿疼痛评估和管理相关的最新证据。
