Faculty Collaboration Database

Is there an alternative to continuous opioid infusion for neonatal pain control? A preliminary report of parent/nurse-controlled analgesia in the neonatal intensive care unit. Paediatr Anaesth 2014 Apr;24(4):377-85

Date

01/15/2014

Pubmed ID

24417623

Pubmed Central ID

PMC4331187

DOI

10.1111/pan.12332

Scopus ID

2-s2.0-84896391833 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

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 postsurgical neonates and young infants.

METHODS: Twenty infants treated with morphine PNCA were retrospectively compared with 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 μg · kg(-1) · h(-1) morphine equivalents, range 0.0-31.4) received significantly less opioid (P < 0.001) than the COI group (median 40.0 μg · kg(-1) · h(-1) morphine equivalents; range 20.0-153.3), across postoperative 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 < 0.05). 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 postsurgical 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.

Author List

Czarnecki ML, Hainsworth K, Simpson PM, Arca MJ, Uhing MR, Varadarajan J, Weisman SJ

Authors

Keri Hainsworth PhD Director, Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Michael R. Uhing MD Professor in the Pediatrics department at Medical College of Wisconsin
Jaya L. Varadarajan MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Steven J. Weisman MD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Distribution
Analgesics, Opioid
Female
Fentanyl
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Intensive Care, Neonatal
Male
Nurses
Pain
Pain Management
Pain Measurement
Parents