Believing babies feel pain

By Rita Rubin, USA TODAY

K.J.S. Anand was puzzled. Why did babies require such intensive care after surgery?

So the young pediatrician-in-training took a look at what was going on in the operating room. He was shocked to discover that babies were having surgery with little or no anesthesia.

This was back in the dark ages of the early 1980s at Oxford University, esteemed home of the world's first anesthesiology department. It wasn't as if the Oxford surgeons were performing some sort of macabre experiments on infants. Operating on babies without anesthesia had been a common practice worldwide for nearly 40 years.

"At the time, it was the accepted notion that babies don't feel pain," says Anand, now a professor at the University of Arkansas for Medical Sciences' College of Medicine. "It was also assumed that anesthetic drugs are probably too strong for them, and the babies will die if they're exposed to anesthesia."

That belief went back to the 1940s and 1950s, when doctors lacked the technology to administer precise doses of anesthesia and monitor anesthetized patients' vital functions, Anand says. Many babies died from anesthesia overdoses.

So instead of anesthesia, doctors gave babies large doses of muscle relaxants to paralyze them. No wonder "no one at that time was willing to believe that these babies were experiencing any form of stress," Anand says.

He was skeptical, and his research has proven him right. First, he found that babies' levels of stress hormones after surgery were triple those of anesthetized adults in post-op. Next, he compared stress hormone levels in infant surgical patients randomly assigned to receive anesthesia or not. As he had expected, levels in the anesthetized babies dropped to those of anesthetized adults.

He later conducted a similar study in babies having open-heart surgery at Boston Children's Hospital. In 1992, Anand published his findings, which, for the first time, showed that anesthesia could actually lower babies' risk of dying from surgery.

"There was a quiet revolution that occurred after that," Anand says, "and babies were given anesthesia." Still, he says, many hospitals routinely perform procedures such as drawing blood without first applying an anesthetic on young patients' skin, a practice that could have long-term behavioral and physiological consequences.