No abstract

Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication. We enrolled opioid-dependent children into a prospective, randomized trial of 5- versus 10-day opioid weaning using oral methadone. Children exposed to opioids for an average of 3 wk showed no difference in the number of agitation events requiring opioid rescue (3 consecutive neonatal abstinence scores >8 every 2 h) in either wean group. Most of the events requiring rescue occurred on day 5 and 6 of the wean in both treatment groups. Patients may be able to be weaned successfully in 5 days once converted to oral methadone, with a follow-up period after medication wean to observe for a delayed withdrawal syndrome.

Background Continuous opioid infusion (COI) remains the mainstay of analgesic therapy in the Neonatal Intensive Care Unit (NICU). Parent/Nurse Controlled Analgesia (PNCA) has been accepted as safe and effective for pediatric patients, but few reports include use in neonates. This study sought to compare outcomes of PNCA and COI in post-surgical neonates and young infants. Methods Twenty infants treated with morphine PNCA were retrospectively compared to 13 infants treated with fentanyl COI in a Midwestern pediatric hospital in the United States. Outcome measures included opioid consumption, pain scores, frequency of adverse events and subsequent methadone use. Results The PNCA group (median 6.4 mcg/kg/hr morphine equivalents, range 0.0 – 31.4) received significantly less opioid (P < .001) than the COI group (median 40.0 mcg/kg/hr morphine equivalents; range 20.0 – 153.3), across post-operative days 0-3. Average daily pain scores (based on 0-10 scale) were low for both groups, but median scores differed nonetheless (0.8 PNCA vs 0.3 COI, P < .05). There was no significant difference in the frequency of adverse events or methadone use. Conclusion Results suggest PNCA may be a feasible and effective alternative to COI for pain management in post-surgical infants in the NICU. Results also suggest PNCA may provide more individualized care for this vulnerable population and in doing so, may potentially reduce opioid consumption, however more studies are needed.

Prospectively compare parent/nurse controlled analgesia (PNCA) to continuous opioid infusion (COI) in the post-operative neonatal intensive care unit (NICU) population. Design/Methods: A randomized controlled trial compared neonates treated with morphine PNCA to those treated with morphine COI. The primary outcome was average opioid consumption up to 3 post-operative days. Secondary outcomes included 1) pain intensity, 2) adverse events that may be directly related to opioid consumption, and 3) parent and nurse satisfaction. Results: The sample consisted of 25 post-operative neonates and young infants randomized to either morphine PNCA (n ¼ 16) or COI (n ¼ 9). Groups differed significantly on daily opioid consumption, with the PNCA group receiving significantly less opioid (P ¼ .02). Groups did not differ on average pain score or frequency of adverse events (P values > .05). Parents in both groups were satisfied with their infant's pain management and parents in the PNCA group were slightly more satisfied with their level of involvement (P ¼ .03). Groups did not differ in nursing satisfaction. Conclusions: PNCA may be an effective alternative to COI for pain management in the NICU population. This method may also substantially reduce opioid consumption, provide more individualized care, and improve parent satisfaction with their level of participation. Clinical Implications: Patients in the NICU represent one of our most vulnerable patient populations. As nurses strive to provide safe and effective pain management, results of this study suggest PNCA may allow nurses to maintain their patients' comfort while providing less opioid and potentially improving parental perception of involvement. Study Type: Treatment study. Level of Evidence: I.