A Pilot Randomized Controlled Trial of Outcomes Associated with Parent-Nurse Controlled Analgesia vs. Continuous Opioid Infusion in the Neonatal Intensive Care Unit |
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| Institution: | 1. Jane B. Pettit Pain and Headache Center, Children''s Hospital of Wisconsin, Milwaukee, Wisconsin;2. Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin;3. Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin;4. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin;6. Department of Surgery, Section of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin;5. Department of Pediatrics, Section of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin;7. Department of Pharmacy, Children''s Hospital of Wisconsin, Milwaukee, Wisconsin;1. Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa;2. College of Nursing, University of Iowa, Iowa City, Iowa;3. Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa;1. College of Nursing, University of Iowa, Iowa City, Iowa;2. Carver College of Medicine, University of Iowa, Iowa City, Iowa;3. Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa;1. Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania;2. NewCourtland Center for Transitions and Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania;3. Wayne State University, College of Nursing, Wayne, Michigan;4. Bendheim Integrative Medicine Center, Memorial Sloan Kettering Cancer Center, New York, New York;1. Pain Service, Swedish Covenant Hospital, Chicago, Illinois, USA;2. School of Nursing, Northern Illinois University, DeKalb, Illinois, USA |
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| Abstract: | PurposeProspectively compare parent/nurse controlled analgesia (PNCA) to continuous opioid infusion (COI) in the post-operative neonatal intensive care unit (NICU) population.Design/MethodsA randomized controlled trial compared neonates treated with morphine PNCA to those treated with morphine COI. The primary outcome was average opioid consumption up to 3 post-operative days. Secondary outcomes included 1) pain intensity, 2) adverse events that may be directly related to opioid consumption, and 3) parent and nurse satisfaction.ResultsThe sample consisted of 25 post-operative neonates and young infants randomized to either morphine PNCA (n = 16) or COI (n = 9). Groups differed significantly on daily opioid consumption, with the PNCA group receiving significantly less opioid (P = .02). Groups did not differ on average pain score or frequency of adverse events (P values > .05). Parents in both groups were satisfied with their infant's pain management and parents in the PNCA group were slightly more satisfied with their level of involvement (P = .03). Groups did not differ in nursing satisfaction.ConclusionsPNCA may be an effective alternative to COI for pain management in the NICU population. This method may also substantially reduce opioid consumption, provide more individualized care, and improve parent satisfaction with their level of participation.Clinical ImplicationsPatients in the NICU represent one of our most vulnerable patient populations. As nurses strive to provide safe and effective pain management, results of this study suggest PNCA may allow nurses to maintain their patients' comfort while providing less opioid and potentially improving parental perception of involvement.Study TypeTreatment study.Level of EvidenceI. |
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