Intermittent Versus Continuous and Intermittent Medications for Pain and Sedation After Pediatric Cardiothoracic Surgery; A Randomized Controlled Trial

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 patient...

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Bibliographic Details
Published in:	Critical care medicine Vol. 46; no. 1; pp. 123 - 129
Main Authors:	Penk, Jamie S., Lefaiver, Cheryl A., Brady, Colleen M., Steffensen, Christine M., Wittmayer, Kimberly
Format:	Journal Article
Language:	English
Published:	United States by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc 01-01-2018 Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc
Subjects:	Analgesics, Opioid - administration & dosage Cardiac Surgical Procedures Child, Preschool Dose-Response Relationship, Drug Drug Administration Schedule Female Humans Hypnotics and Sedatives - administration & dosage Infant Ketorolac - administration & dosage Male Midazolam - administration & dosage Morphine - administration & dosage Pain Measurement - drug effects Pain, Postoperative - drug therapy Thoracic Surgical Procedures
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Summary:	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.
ISSN:	0090-3493 1530-0293
DOI:	10.1097/CCM.0000000000002771