Table 2.

Recommended neonatal and infant analgesic interventions and dosing

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