Pediatric patient pain

WSAVA guideline

Key findings

• Neonates feel and "remember" pain: human infants denied analgesia show increased sensitivity at later procedures (Taddio 1997); applies to animals. Paediatric = kitten/puppy up to 12 weeks (card; §3.10).
• Four immaturities reduce clearance: ↑body water → higher Vd; larger highly perfused tissue mass; incomplete hepatic-enzyme maturation; ↓GFR — dosing intervals may need alteration. CNS drugs reach higher neonatal brain levels (BBB/efflux immaturity) (card).
• Opioids: lower fentanyl/morphine doses needed at 0–2 wk vs 5 wk; young more sensitive to morphine sedation/respiratory depression; fentanyl suitable but short-acting (continuous IV + titration); buprenorphine alternative, minimal respiratory depression; reverse overdosage with titrated naloxone. Hydromorphone antinociception in cats shorter/lower at 6 vs 9–12 months (card).
• NSAIDs: rarely authorised <12–16 wk, but meloxicam approved ≥6 wk in some countries; 380 kittens (8–12 wk) given carprofen/meloxicam pre-neutering — no adverse effects (Porters 2015); ensure not hypovolaemic/hypotensive (card).
• Local anaesthetics whenever possible; topical EMLA (2.5% lidocaine/2.5% prilocaine) or 4% liposomal lidocaine, occlusive dressing, onset 15–20 min; reduce repeat doses/CRI rates vs adults (accumulation) (card).
• Alpha-2 agonists not recommended (neonatal cardiac output is HR-dependent; α2 bradycardia), yet α2+ketamine+opioid total-injectable protocols succeed in kittens <12 wk. Non-pharmacologic care: suckling, swaddling, dam/human contact, warmth; avoid separation from littermates/dam (card).

Drugs named in WSAVA’s own guideline text

As printed in WSAVA’s document, not this app’s own extracted data — see “Related drugs in this reference” below for that.

• Fentanyl / morphine / buprenorphine (Puppy/kitten)

• Carprofen or meloxicam (Kitten 8–12 wk)

• EMLA (lidocaine 2.5%/prilocaine 2.5%) or 4% liposomal lidocaine (Puppy/kitten)

• Injectable local anaesthetics (Puppy/kitten)

• Medetomidine/dexmedetomidine + ketamine + opioid (Kitten <12 wk)

Recommendations

• Treat neonatal pain — neonates feel and "remember" it

  Strong (human-neonate data; GPC)

• Opioids as backbone; prefer fentanyl (IV titration) or buprenorphine; reverse overdose with titrated naloxone

  Expert consensus (GPC); Luks 1998

• NSAIDs permissible with screening (not hypovolaemic/hypotensive)

  Clinical series (Porters 2015) + GPC

• Use LA techniques whenever possible; reduce repeat/CRI doses vs adults

  Expert consensus (GPC)

• Avoid α2 agonists as a class, accepting published α2+ketamine+opioid protocols

  Expert consensus (GPC); Joyce & Yates 2011

• Pair drugs with non-pharmacologic care (suckling, swaddling, warmth); clinical response guides dosing

  Expert consensus (GPC)

Related drugs in this reference (0)

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