**7. Postoperative pain management**

High dose opioids are given during paediatric congenital heart surgery and analgesic effect continues in postoperative period. Good intraoperative and postoperative analgesia is associated with improved surgical outcome22. Morphine in the doses of 25 microgram/kg/hr will provide adequate analgesia and moderate sedation during postoperative period while additional sedatives are needed in intubated patients. Larger doses are needed in infants and young children basically due to high clearance.

Fentanyl at the doses of 1-5 microgram/kg/hr can be given instead to provide continuous analgesia but associated with less sedation then morphine. Non opioid analgesics like acetaminophen and ketamine can also be used as an adjunct to opioid analgesia. Ketamine is given intravenously as a bolus or in the form of continuous infusion at the rate of 10 – 45 microgram/kg/min.
