Surfactant deficiency remains a significant cause of mortality and morbidity in preterm infants.1 The Less Invasive Surfactant Administration (LISA) procedure involves laryngoscopy and intratracheal surfactant administration via a thin catheter during spontaneous breathing supported by nasal CPAP or other types of non-invasive support or ventilation.2 In a recent study including 153 international LISA experts from 14 countries, 41% indicated no use of analgesic premedication for LISA, while 49% reported using fentanyl.3 On the contrary, non-pharmacological comfort care was used extensively for LISA but with no standardized approach.