<p>Neonatal postoperative pain management in Japan is not as standardized as bedside procedural pain, where evidence-based guidelines are widespread, which causes a knowledge gap. To identify postoperative pain management issues, we analyzed the anonymous survey online or by mail by neonatologists or head nurses in 89 Japan's neonatal intensive care units (levels III and IV). Although 79 units (88.8%) required recommendation for postoperative pain management, 11 units (12.4%) used a pain scale for pain assessment, 35 units (39.3%) had evaluated and recorded the pain assessment, 27 units (30%) had updated the postoperative pain management plan, less than bedside procedure, and 14 units (15.7%) had made a preoperative pain management plan. Pain management among neonatal nurses and neonatologists and pediatric surgeons and anesthesiologists have been in three units (3.4%) for preoperative, and in six units (6.7%), and postoperative pain management consult was provided in 15 units (16.9%), which means Initiatives at facilities are essential. We suggest evidence-based practical recommendations in Japan are necessary for neonates to minimize postoperative pain, enhance neonatal postoperative pain management knowledge, and provide consistent postoperative pain management appropriate to the neonates' condition by multidisciplinary collaboration among neonatal nurses, neonatologists, pediatric surgeons, and pediatric anesthesiologists.</p>