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Intermittent Versus Continuous and Intermittent Medications for Pain and Sedation After Pediatric Cardiothoracic
Jamie S Penk1, Cheryl A Lefaiver, Colleen M Brady
1All authors: Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL.
Insights
Continuous infusions of morphine and midazolam did not improve pain control in pediatric cardiac surgery patients. This strategy led to higher medication doses and longer hospital stays compared to intermittent dosing alone.
Area of Science:
- Pediatric Cardiac Surgery
- Pain Management
- Sedation Strategies
Background:
- Effective pain and sedation management is crucial for pediatric patients recovering from cardiac surgery.
- Optimizing medication strategies can improve patient outcomes and reduce healthcare resource utilization.
Purpose of the Study:
- To compare the efficacy of continuous infusions of morphine and midazolam plus intermittent dosing versus intermittent dosing alone for pain and sedation in pediatric cardiac surgery patients.
- To evaluate the impact of these strategies on medication requirements and hospital length of stay.
Main Methods:
- A randomized controlled trial involving sixty pediatric patients (3 months to 4 years) undergoing early extubation after cardiac surgery.
- Patients received either continuous infusions of morphine and midazolam plus as-needed intermittent doses, or intermittent doses only, for 24 hours post-surgery.
- Pain was assessed using the Faces, Legs, Activity, Cry, And Consolability (FLACC) score.
Main Results:
- No significant differences in FLACC scores or the number of intermittent doses were observed between the groups.
- The continuous/intermittent infusion group received significantly higher total doses of morphine (0.90 vs 0.23 mg/kg) and midazolam (0.90 vs 0.18 mg/kg).
- The continuous/intermittent infusion group experienced a longer hospital length of stay (8.4 vs 4.9 days).
Conclusions:
- Adding continuous infusions of morphine and midazolam to intermittent dosing did not provide superior pain control compared to intermittent dosing alone in this patient population.
- The use of continuous infusions resulted in increased total medication dosages and a prolonged hospital stay.
Objectives:
Compare continuous infusions of morphine and midazolam in addition to intermittent doses with an intermittent only strategy for pain and sedation after pediatric cardiac surgery.
Design:
Randomized controlled trial.
Setting:
Advocate Children's Hospital, Oak Lawn, IL.
Patients:
Sixty patients 3 months to 4 years old with early extubation after pediatric cardiac surgery.
Interventions:
Patients received a continuous infusion of morphine and midazolam or placebo for 24 hours. Both groups received intermittent morphine and midazolam doses as needed.
Measurements And Main Results:
Gender, age, bypass time, and surgical complexity were not different between groups. Scheduled ketorolac and acetaminophen were used in both groups and were not associated with adverse events. The mean, median, and maximum Faces, Legs, Activity, Cry, And Consolability score were not different between groups. There was no significant difference in number of intermittent doses received between groups. The total morphine dose was higher in the continuous/intermittent group (0.90 vs 0.23 mg/kg; p < 0.01). The total midazolam dose was also higher in the continuous/intermittent group (0.90 vs 0.18 mg/kg; p < 0.01). The hospital length of stay was longer in the continuous/intermittent group (8.4 vs 4.9 d; p = 0.04).
Conclusions:
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.
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