However, nausea and vomiting is a major disadvantage in older children. PCA allows children to adjust the degree of pain relief to their own desired level of comfort and tolerance side effects, and offers superior analgesia to intermittent injections. Opioids in neonates and infants. This relates to liver enzyme inmaturity and different pathways of metabolism. The unpredictable response to opioids by neonates is the greatest problem for clinicians.
Most practitioners reduce the initial and infusion dose for infants up to six months of age.
Careful patient assessment during treatment with monitoring in a high dependency setting is obligated in these children. By the age 1 month plasma half-life and clearance approach adult levels, and both clearance and protein binding are at adult levels at the age 6 months, which allows the use of greater infusion rates even in spontaneously ventilating patients. Peripheral nerve blocks are employed extensively in day-case surgery in our institution. A continous epidural infusion with bupivacaine is used with the addition of an opiod, fentanyl, which improves the quality of the analgesia, allows a lower dose of bupivacaine to be used and prevents tachyphylaxis. If the catheter is required may be possible its advance to lumbar o thoracic level in small infants.