I'm wondering what you guys do for pain control in ventilated infants? I work in a teaching hospital, and many of the 'docs' take cues from us as to what needs to be ordered, what would be best for the baby, etc. I'm concerned that pain issues are not being addressed for many of these babies. For instance, many ventilated infants on our unit have orders for Ativan, some also have Versed (both PRN q 2-4), and one in a great while has Morphine ordered PRN. Now, forgive me- I'm still learning...but I was under the impression that Versed and Ativan had no analgesic properties? It is the rare baby who has an order for Morphine, and it's usually only temporary, as in post-surg, etc. Also, we have no sucrose on the unit, and it seems that some of the people I work with don't even encourage sucking as a method of soothing the baby. I'm confused!!!! What do you guys give for pain control, why do you give it, and how often? Scenarios welcome- I am a bit lost here! Thanks!

All HFV babies are on a continuous MS04 and Versed infusion.Others we give a one time or PRN MS04and if they appear to need it do continuous. We don't get many surgical, so this would be your vented, possibly chest tubes and the like.

How important do you think the Morphine is for these HFOV babies? As I mentioned, usually the orders are for PRN morphine, and I have questions about the effectiveness of this, not to mention the actual *need* for Morphine. How do you gauge the level of pain in these infants in a way that leads you to decide on the Morphine drips (and by you, I mean you and the physicians)? I guess what I'm asking is how do you know if they 'appear to need it'? I can usually decide when a baby needs Ativan or Versed, for agitation, but am having a bit of difficulty with figuring out actual PAIN....?

Ah...the age old battle! For the longest time we used NOTHING on our kids, no matter how hard they fought. Then we went to everyone got Pavulon and MSO4. Now I would say most of our sickest HFOV kids and others on volume or sometimes conventional are on Fentanyl drips. The only bad thing with Fentanyl is that one can build a tolerance within 24 hours! We also have used Versed or MSO4 gtts. We tend to stay away from MSO4 because of the effects on the bowel, but we do use it as a PRN.

We also use the poopy cries scale to help determine pain management, the inability to wean the vent is the other thing we go by.

Versed and Ativan are more Valium like in there properties. We don't use Ativan often, something with the half life and the way it is metabolized. We also avoid Versed with our little ones...we have had quite a few seize or have clonic movements from it.

For example...you have a former 24 weeker that is just not weaning from the osc. or conventional...is crabby all the time. We will try nesting, positioning. If that doesn't work, we usually beg for one dose of something to see if Baby will calm down and not sat 60%. Usually Baby likes it and drifts into lala land and is satting 100%. We made our point and we can usually cajole at least a PRN order out of them.

Good luck...it is never easy to tell them, yes my little one is not enjoying life right now! If they were adults they would be screaming!!!!

We give all ventalated babies Morphine by continious infusion not so much as a analgesia but for its sedatory effects after all you would not dream of ventilating an adult with out some form of sedation would you so why do we with babies?

It makes them easier to ventilate and often if they are fighting the vent of have a high o2 requirement, increasing the morphine of (even paralizing with Panc/Vecaronium too in some cases) can make there management much easier and reduce there o2 requirement.

When we are planning to wean off the vent we turn down the morphine a few babies who have been very sick have oramorph for a while afterwards it they have been on high dose for a long while.

Please forgive me for posting here-I am not a NICU nurse, but I came across this topic and thought I would reply.

My son was on the vent in his last 24 hours of life. The nurses in the NICU where he was gave him Fentanyl for pain.

I am GRATEFUL as a parent that his pain was controlled!

Ginger

We had an entire year of pain education. I feel our unit does a good job of managing pain. We use the N-pass, it scores on gestation, movement, cry, facial expression, vs....... We generally give MSO4 based on the score. We alternate with versed if needed. Bigger kids sometimes get chloral or ativan. But now most NNP's and MD's will ask the N-pass score.

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I noticed in my training they gave vent kids a fentanyl and it worked beautifully and they were weaned off it gradually. some docs are not agressive when it comes to pain control and it does that tiny baby unjustice when they aren't comfortable.

The only 2 medications that are appropriate for pain control mentioned on this page are Fentanyl and Morphine - narcotic opiods. The others Ativan, Versed, Valium (Benzos) - anti-anxiety, antiSZ, sedative effect, not pain relief. Chloral Hydrate can be a dangerous medication and is not used as often as it used too - It does not manage pain, it is used for sedation. Ketamine is one drug that can produce a sedative/amnesia effect and pain relief, but I do not think it would be used in neonates. I would hope that anyone who was on a high frequency vent was paralyzed AND sedated. I unfortunately think that we do not give the little ones enough pain medication.

Hope that helps.........

Keep in mind that this thread is quite old and that practices do change significantly over time.

Keep in mind that this thread is quite old and that practices do change significantly over time.

Right. This thread is almost four years old, before pain became the fifth vital sign!

Well, as long as the thread is here, there is something I'd like to ask for my own education.

My cousin had a CDH baby. After surgery they left the epidural in for pain control. After the epidural was removed, the nurse mentioned something about checking his pupils to gauge his pain control. My question is, what was she looking for? Do the pupils become sluggish in the neonate in response to pain?

Thanks, everyone.