Paediatric pain management: from personal-biased to evidence-based

In this study we have shown that neonates and infants up to I year of age may receive intermittent morphine doses, thereby avoiding the excessive fluid intake and the need of infusion equipment. Older infants (I - 3 years) may require either a continuous infusion, or more frequent dosing regimens (every 1 - 2 hours) or judicious increases in the intermittent doses used for postoperative morphine analgesia. We speculate that combined therapy with different classes of analgesics and sedative drugs will provide more effective control of physiological and behavioural responses, especially in toddlers 1 - 3 years of age, who may have a high level of anxiety in the PICU environment. Further studies are needed to establish the efficacy and safety of such combinations, i.e. morphine combined with midazolam, paracetamol or a NSA!D. These studies will not only provide a scientific framework for the postoperative management of neonates and young infants, but may also provide clues to elucidate the development of pain and stress-responsive systems in the developing brain.

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