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

Authors

  • Michelle L. Czarnecki,

    Corresponding author
    1. Jane B. Pettit Pain Management Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
    • Correspondence

      Michelle L. Czarnecki, Jane B. Pettit Pain Management Center, Children's Hospital of WI, 9000 W. Wisconsin Ave., P.O. Box 1997, MS 792, Milwaukee, WI 53201, USA

      Email: mczarnecki@chw.org

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  • Keri Hainsworth,

    1. Jane B. Pettit Pain Management Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
    2. Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
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  • Pippa M. Simpson,

    1. Department of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
    2. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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  • Marjorie J. Arca,

    1. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
    2. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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  • Michael R. Uhing,

    1. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
    2. Department of Neonatology, Medical College of Wisconsin, Milwaukee, WI, USA
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  • Jaya Varadarajan,

    1. Jane B. Pettit Pain Management Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
    2. Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
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  • Steven J. Weisman

    1. Jane B. Pettit Pain Management Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
    2. Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
    3. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Summary

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.

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