The hospitalized newborn is exposed to many unpleasant, painful procedures during the neonatal period. A Neonatal Intensive Care Unit (NICU) patient receives between 7.5 to 17.3 painful procedures per day 1 and experiences significant moderate and severe postoperative pain. 2 It is essential to recognize pain in neonates and adequately assess it using appropriate pain scales. The plasticity of the neonatal brain increases its vulnerability to painful stimuli, leading to abnormal neurodevelopmental, behavioral, and cognitive outcomes. 3,4,5

For neonatal well-being, it is essential to prevent and treat pain rapidly, preventing short and long-term effects of neonatal pain. Various interventions to reduce pain have been studied. Opioids have traditionally been used in the NICU, despite several side effects such as respiratory depression. A range of practical and safe regional techniques for pain control has been developed recently. Regional anesthesia provides good pain relief in neonates and is performed for operative and postoperative analgesia. 6, 7, 8, 9, 10, 11, 12, 13 It decreases the need for intraoperative and postoperative opioids, reduces the adverse drug effects, and facilitates early extubation. It suppresses the stress response and can prevent long-term behavioral responses to pain.14

Pain prevention whenever possible using multimodal analgesia that includes regional anesthesia techniques has worked well. This chapter will focus on postoperative pain control and clinical applications of regional anesthesia in neonates.