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!!!!