Intermittent Versus Continuous and Intermittent Medications for Pain and Sedation After Pediatric Cardiothoracic Surgery; A Randomized Controlled Trial*

Abstract

Pain was not better controlled with the addition of continuous infusions of morphine and midazolam when compared with intermittent dosing only. Use of continuous infusions resulted in a significantly higher total dosage of these medications and a longer length of stay.

Analgesia and sedation in patients with ARDS

“…CAM-ICU: Confusion Assessment Method -Intensive Care Unit [2]. ICDSC: Intensive Care Delirium Screening Checklist [2] and continuous administration, an RCT in children who underwent cardiothoracic surgery [32] and an observational study in adults [33] suggest that intermittent strategy may be associated with less drug administration and shorter duration of MV. However, further studies are needed before an intermittent rather than continuous administration approach can be recommended in all patients.…”

“…When added to a sedation protocol which targets light sedation, a daily interruption strategy does not further reduce MV days [ 26 ]. While there are no randomized controlled trials (RCT) in adults with ARDS comparing intermittent and continuous administration, an RCT in children who underwent cardiothoracic surgery [ 32 ] and an observational study in adults [ 33 ] suggest that intermittent strategy may be associated with less drug administration and shorter duration of MV. However, further studies are needed before an intermittent rather than continuous administration approach can be recommended in all patients.…”

Post-Cardiotomy Parasternal Nerve Block with Bupivacaine May Be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study

“…Despite the use of multi-modal analgesia, adequate pain treatment and prevention after pediatric cardiac surgery continues to represent the challenge of balancing effective pain control with limiting opioid-induced side-effects, sedation, and respiratory effects [14][15][16][17][18][19][20]. Additional evidence regarding analgesic modalities to improve immediate postoperative and long-term outcomes is needed.…”

“…Hospitalized children experiencing severe pain without adequate analgesia show negative long-term consequences, including a higher risk for post-traumatic stress disorder and increased morbidity and mortality [9][10][11][12][13]. Effective pain treatment after cardiac surgery in the pediatric population presents the challenge of balancing effective pain control with limiting opioid-induced side-effects, sedation, and respiratory effects [14][15][16][17][18][19][20].…”

Pediatric Cardiac Surgery and Pain Management: After 40 Years in the Desert, Have We Reached the Promised Land?

“…There is a significant importance to the management strategy, as both under- and overtreatment in regard to opioid administration should be avoided. In a recently published trial, Penk at el 50 compared continuous infusions of morphine and midazolam in addition to intermittent doses with an intermittent-only strategy for pain and sedation after pediatric cardiac surgery. Sixty patients aged three months to four years with early extubation after pediatric cardiac surgery were randomly assigned to either the intermittent-only or continuous/intermittent group.…”