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Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines
D Rana1,2, B Bellflower1,2, J Sahni3
1Division of Neonatal Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
Insights
Implementing new pain guidelines in a neonatal intensive care unit (NICU) significantly reduced opioid and sedative use in infants. This also decreased the incidence of iatrogenic opioid withdrawal, improving infant care.
Area of Science:
- Neonatalogy
- Pharmacology
- Evidence-based Medicine
Background:
- Neonatal intensive care units (NICUs) face challenges in managing infant pain and sedation.
- Opioid and benzodiazepine use in critically ill neonates can lead to adverse effects, including withdrawal.
Purpose of the Study:
- To evaluate the impact of newly implemented pain management guidelines on opioid and benzodiazepine usage in a level IV NICU.
- To assess changes in the incidence of iatrogenic opioid withdrawal following guideline implementation.
Main Methods:
- Development of evidence-based guidelines for pain management in infants undergoing surgery or mechanical ventilation.
- Comparative analysis of opioid and sedative exposure data collected during two periods: pre-guideline (July-December 2013) and post-guideline (March-August 2014).
Main Results:
- Opioid exposure decreased significantly from 62.9% to 32.8% (P<0.001).
- Cumulative opioid and sedative doses (morphine and midazolam equivalents) were significantly reduced.
- The number of infants requiring treatment for iatrogenic opioid withdrawal decreased from 10 to 3 (P=0.02).
Conclusions:
- Evidence-based pain management guidelines effectively reduced opioid and sedative exposure in the NICU.
- Guideline implementation led to a significant decrease in the need for methadone treatment for neonatal opioid withdrawal syndrome.
Objective:
To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines.
Study Design:
Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014).
Results:
Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods. Number of patients exposed to opioids decreased from 62.9% (129/205) in period 1 to 32.8% (82/250) in period 2, P=<0.001. Cumulative dose exposure decreased, opioids in morphine equivalent dose, mg kg-1 (1.64 (0.38 to 6.94) vs 0.51 (0.04 to 2.33), P=0.002), sedatives in midazolam equivalent, mg kg-1 (0.16 (0.03 to 7.39) vs 0.10 (0.00 to 4.00), P=0.03). Ten patients required treatment for iatrogenic opioid withdrawal versus only three in post guideline, P=0.02.
Conclusions:
Evidence-based guidelines led to significant reduction in opioids and sedatives exposure, and in the number of infants requiring methadone for iatrogenic narcotic dependence.
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