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Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines

Journal of Perinatology volume 37, pages 1038–1042 (2017)Cite this article

Subjects

Abstract

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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Author information

Authors and Affiliations

  1. Division of Neonatal Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA

    D Rana, B Bellflower, A J Kaplan, N T Owens, E L Arrindell Jr., A J Talati & R Dhanireddy

  2. Le Bonheur Children’s Hospital, Memphis, TN, USA

    D Rana, B Bellflower, E L Arrindell Jr., A J Talati & R Dhanireddy

  3. Department of Clinical Pharmacy, Le Bonheur Children’s Hospital, Memphis, TN, USA

    J Sahni

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  1. D Rana
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  2. B Bellflower
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Correspondence to D Rana.

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Rana, D., Bellflower, B., Sahni, J. et al. Reduced narcotic and sedative utilization in a NICU after implementation of pain management guidelines. J Perinatol 37, 1038–1042 (2017). https://doi.org/10.1038/jp.2017.88

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