Safety profile and efficacy of commonly used analgesics in surgical neonates in Benin City, Nigeria

Abstract

We reviewed commonly used analgesics and determined their safety and efficacy in surgical neonates in a retrospective study on surgical neonates who had analgesics at the University of Benin Teaching Hospital between January 1998 and December 2007. A total of 2590 pediatric operations were performed on 2563 children; 368 (14.2%) on neonates, 256 boys and 112 girls with male:female ratio 2.3:1, aged 12 hours to 28 days (mean, 8 +/- 5.1 days), and weighing 1.8 to 4.9 kg (mean, 2.7 +/- 0.5 kg). Paracetamol, pentazocine, pethidine, fentanyl, tramadol, and breast milk/glucose drinks were common analgesics and pacifiers used, and morphine, meperidine, alfentanil, and ketorolac were rarely used during the period. Opioids, especially pentazocine, produced satisfactory analgesia but were associated with life-threatening morbidities and mortalities, chiefly due to respiratory depression compounded by nonavailability of pediatric ventilator ( P < 0.0001). Excessive sedation, apnea, and mucous/vomiting were other complications. Nonsteroidal anti-inflammatory agents, particularly tramadol, had excellent analgesia with no significant complication. Overall, 18 (4.9%) deaths were recorded, 15 (83.3%) of them following pentazocine use. Many analgesics relieved pain but most were unsafe; cautious selection is important where there may be no adequate facilities.