Pain Reduction Effects of Continuous Fentanyl Infusion to Intensive Care Neonates

Hwang, Wi Kyung; Kim, Heng Mi

Abstract

PURPOSE: To determine whether pain control using fentanyl would effectively reduce behavioral distress, physiologic and hormonal responses to postoperative pain and mechanical ventilation in neonates.
METHODS
Neonates who were admitted to the NICU(neonate intensive care unit) of Kyungpook University Hospital, requiring surgery or mechanical ventilation were evaluated. Twelve neonates undergoing operation were randomised into two groups. After operation, one group received fentanyl and the other was given saline. Behavioral distress using postoperative comfort scores, heart rate, blood pressure and blood glucose were evaluated before and after operation. Cortisol concentration and beta endorphin were measured before and at the end of operation and at 60 minutes after fentanyl infusion. The values were compared between the two groups. In eight neonates on mechanical ventilation, behavioral distress using pain scores, heart rate, blood pressure, oxygen saturation and concentrations of cortisol and beta endorphin were measured before and 60 minutes after fentanyl infusion.
RESULTS
In neonates undergoing surgery, fentanyl infusion diminished the elevation of post operation heart rate and blood glucose(P<0.05) and induced the improvement of postoperation comfort scores(P<0.05). Cortisol levels were significantly lower in neonates receiving fentanyl(P< 0.01) at 60min after infusion. In neonates on mechanical ventilaion, fentanyl infusion diminished the elevation of systolic blood pressure and heart rate on endotracheal suction(P<0.05). At 60 minutes after infusion, cortisol levels were markedly lower in neonates receiving fentanyl(P<0.05).
CONCLUSION
Neonates feel pain during postoperation and on mechanical ventilation. As fentanyl therapy appears to be effective in controlling the pain, anaesthetic agents should be given to all neonates undergoing painful procedures or under painful situations.