POSTOPERATIVE PATIENT-CONTROLLED ANALGESIA IN THE PEDIATRIC CARDIAC INTENSIVE CARE UNIT
Epstein HM. Crit Care Nurse. 2017;37(1):55-61.
In this practice improvement project, the researcher sought to determine whether pain-related clinical outcomes in patients aged 10 years to adult were improved by using a patient-controlled analgesia (PCA) as a pain management strategy. Furthermore, the researcher sought to clarify existing knowledge gaps for management of pain in poststernotomy cardiac patients in the pediatric intensive care unit. The author compared retrospectively use of as-needed medication and pain scores from before to after initiation of the PCA.
During this 8-week trial, the researcher collected pain scores of all PCA uses through their stay in the pediatric intensive care unit, additional as-needed pain medications, and pain scores before and after delivery. The PCAs contained morphine, and it was found that the cumulative mean pain score from the time of extubation through the next 24 hours decreased from 4.14 (using a pain scale of 0-10) when only as-needed pain medications were used to 2.8 with a PCA.
The researcher concluded that the use of PCA for postoperative pain was efficient and effective. It was also found that a barrier to implementation of the PCA was related to a lack of advocacy for the use of the PCA after extubation.
EFFECT OF RECTAL ACETAMINOPHEN WITH INTRAVENOUS OPIOID ON COMFORT LEVELS AND OPIOID USE IN FULL-TERM INFANTS POST-OPEN HEART REPAIR
Ochsenreither JM, Ramsey EZ, Mest CG, DiMaggio T. Pediatr Nurs. 2017;43(4).
The objective of this retrospective, 18-month study was to compare comfort levels and overall opioid use between 2 groups of full-term infants with a congenital heart defect within 24 hours or less after open heart surgery. An aim of this project was to accurately identify, document, and analyze comparison findings specific to comfort levels and overall opioid use in full-term infants with congenital heart defect after open heart surgery who received rectal acetaminophen in conjunction with intravenous (IV) opioid versus IV opioid alone. Another aim of this project was to develop and implement a practice change protocol or clinical pathway.
Infants (n = 74) were compared for comfort levels and overall opioid exposure within 24 hours or less after open heart repair. Fifty-three infants received rectal acetaminophen in conjunction with IV opioid, and 21 infants received IV opioid only. Using a consistent pain scale, the researchers found that the infants who were prescribed rectal acetaminophen in conjunction with IV opioid had no significant difference in comfort levels as compared with infants who received IV opioid only (P < .08) but had a statistically significant (P < .01) decrease in overall opioid exposure (0.11 mg/kg per day) as compared with infants who received IV opioid only (0.28 mg/kg per day).
The researchers recommend the adjuvant use of rectal acetaminophen with IV opioid to reduce overall opioid exposure, dosing rectal acetaminophen at 40 mg/kg per dose, and the development of a clinical pathway using a valid and accurate pain assessment tool in the postoperative period.