Associate Professor of Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine; UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, PA, United States of America.
Semin Pediatr Surg. 2022 Aug;31(4):151203. doi: 10.1016/j.sempedsurg.2022.151203. Epub 2022 Aug 1.
Neonates experience significant moderate and severe postoperative pain. Effective postoperative pain management in neonates is required to minimize acute and long-term effects of neonatal pain. Protecting the developing nervous system from persistent sensitization of pain pathways and developing primary hyperalgesia is essential. Opioids and acetaminophen are commonly analgesics used for pain control. Regional anesthesia provides adequate intraoperative and postoperative analgesia in neonates. It decreases exposure to opioids, reduces adverse drug effects, and facilitates early extubation. It suppresses the stress response and can prevent long-term behavioral responses to pain. The most common blocks performed in neonates are neuraxial blocks. Using ultrasound increased the number of peripheral nerve blocks performed in neonates. Recently, various peripheral nerve blocks (paravertebral, transverse abdominis plane, rectus sheath, quadratus lumborum, erector spinae plane blocks) were safely used. Many studies support analgesic efficacy but highlight neonates' unpredictability and variability of fascial blocks.
新生儿经历明显的中度和重度术后疼痛。需要对新生儿进行有效的术后疼痛管理，以最大程度地减少新生儿疼痛的急性和长期影响。保护发育中的神经系统免受疼痛通路的持续致敏和原发性痛觉过敏的发生至关重要。阿片类药物和对乙酰氨基酚是常用的镇痛药物，用于控制疼痛。区域麻醉可在新生儿中提供充分的术中及术后镇痛。它可减少阿片类药物的暴露，降低药物不良反应，并有助于早期拔管。它可抑制应激反应，并可预防对疼痛的长期行为反应。在新生儿中最常进行的阻滞是神经轴阻滞。使用超声增加了在新生儿中进行的外周神经阻滞的数量。最近，各种外周神经阻滞（椎旁、腹横平面、腹直肌鞘、竖脊肌平面阻滞）也被安全使用。许多研究支持其镇痛效果，但强调了新生儿筋膜阻滞的不可预测性和可变性。
