Increasing Caudal Block Utilization to Promote Opioid Stewardship in the NICU Population: A Quality Improvement...

Area of Science:

• Anesthesiology
• Neonatal Care
• Pain Management

Background:

• Regional anesthetic techniques are effective for pain reduction and decreasing opioid requirements.
• Underutilization of regional anesthesia, specifically caudal blocks, is noted in neonatal intensive care unit (NICU) patients.
• An opioid stewardship pathway was implemented to increase caudal block use from 50% to 90% in 18 months.

Purpose of the Study:

• To evaluate the impact of an opioid stewardship pathway on caudal block utilization in neonates.
• To assess changes in intraoperative opioid utilization and postoperative extubation rates.
• To monitor unrelieved pain and reintubation rates as balancing measures.

Main Methods:

• Control charts tracked intraoperative opioid use (MME/kg) and postoperative extubation rates.
• Balancing measures included unrelieved pain (NPASS scores >/= 4), postoperative opioid use, and 24-hour reintubation.
• Statistical analysis compared outcomes between surgeries with and without caudal blocks.

Main Results:

• Caudal block utilization increased to 63% post-intervention.
• Intraoperative opioid utilization decreased (0.230 vs 0.416 MME/kg), and extubation rates increased (75% vs 70%).
• Caudal blocks were associated with significantly decreased intraoperative opioid use (p < 0.001) and increased extubation rates (p < 0.001), with no rise in pain or postoperative opioid use.

Conclusions:

• A modest increase in caudal block utilization effectively reduced intraoperative opioid requirements in neonates.
• The intervention led to improved postoperative extubation rates without compromising pain control.
• Caudal blocks represent a valuable tool in opioid stewardship for NICU patients.