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Effective pain control after major surgery in neonates presents many challenges. Parenteral opioids (and co-analgesics) are often used but inadequate analgesia and oversedation are not uncommon. Although continuous thoracic epidural analgesia is highly effective and opioid-sparing, its associated risks and the need for staff with specialised skills and/or neonatal intensive care unit staff buy-in may preclude this option even in many academic centres. We present the case of a six-day-old infant who underwent upper abdominal surgery and received intermittent morphine doses via a tunnelled caudal epidural catheter, which provided satisfactory analgesia and facilitated early extubation. [ABSTRACT FROM AUTHOR]

The article discusses a retrospective cohort study that compared pain relief and opioid requirements in the 24 hours following surgery in patients in buprenorphine opioid substitution therapy (BOST) and methadone opioid substitution therapy (MOST) programs taking patient-controlled anesthesia. It mentions the lack of significant differences with regard to pain scores and incidence of nausea requiring treatment or sedation. The suitability of continuing buprenorphine perioperatively is cited.

The article discusses a review on the potential adverse effects of opioids on ventilation. It also discusses the possible effects of opioids in patients with sleep-disordered breathing (SDB), and then the risk opioid-induced ventilatory impairment (OIVI) after opioid administration for the treatment of acute pain including in patients with SDB. The possible strategies that may help to reduce this risk is also discussed.