Table 2.
Analgesic | Type of procedure | Dosing | Other |
---|---|---|---|
Sucrose/glucose | Heel Lance Venipuncture |
Oral: 20–30 % solution Multiple doses are more effective than single [38] |
Optimal Dose has not yet been identified Decrease concentration in preterm neonates [1] |
EMLA (2.5 % lidocaine +2.5 % prilocaine) | Venipuncture Circumcision PICC line insertion Lumbar puncture |
Topical: 0.5–1 g covered with occlusive dressing × 45–60 min Max dose = 1 g |
Not recommended for heel lance; more painful, longer procedure duration SE: common: skin irritation; Rare: methemoglobinemia [51, 53] |
Acetaminophen | Heel lance Finger lance Adhesive removal Dressing change Wound treatment Venipuncture Circumcision |
Oral: 10 mg/kg q6 h or 15 mg/kg q8 h [64] Rectal: 20–25 mg/kg IV: loading dose: 20 mg/kg, then maintenance with [56] TDD: 37–42 weeks = 50–60 mg/kg/day 1–3 months = 60–75 mg/kg/day |
Neonates have slower clearance than older children [64] Rare SE: Hepatotoxicity, Renal Toxicity |
Lidocaine injection | PICC line insertion Lumbar puncture Circumcision |
SQ and IM: 3–5 mg/kg/dose of 0.5 % (5 mg/mL) or 1 % (10 mg/mL) [54] | Toxicity: arrhythmias, seizures Avoid combination with epinephrine in neonates-to minimize risk of arrhythmia and tissue necrosis J-tip/needle free have not been adequately studied [55] |
Opiates | Wound treatment Incision and drainage Lumbar puncture Tracheal intubation Chest tube insertion |
Morphine IV: 0.05–0.1 mg/kg/dose [75] | SE: Hypotension in preterm neonates [63, 65] |
Fentanyl IM/IV: 0.5–1 μg/kg/dose [75] Fentanyl intranasal: 1.5–2 μg/kg/dose [76] |
SE: bradycardia, chest wall rigidity [70], but less hypotension, GI dysmotility and urinary retention than morphine [63, 65–70] | ||
Ketamine | Procedural sedation | IM/IV: 0.5–2 mg/kg/dose | Bronchodilator: improves ventilation Minimal effects on respiratory drive, HR, BP Toxicity: >2 mg/kg/dose bradycardia [73]; >5 mg/kg/dose decreased BP [74] |
TDD total daily dosing; SE side effects