Background

A limited number of post-operative opioid reduction strategies have been implemented in the neonatal population. Given the potential neurodevelopment effects of prolonged opioid use, we created a quality improvement initiative to reduce opioids in our NICU and evaluated the intervention in our CDH population.

Methods

Our opioid reduction intervention was based on standing post-operative IV acetaminophen, standardizing post-surgical sign-out between the surgical, anesthesia and NICU teams and a series of education seminars with NICU providers on post-operative pain control management. A historical control was used to perform a retrospective cohort analysis of opioid prescribing patterns in addition to a utilizing process control charts to investigate time trends in prescribing patterns.

Results

Forty-five children with CDH underwent an operation were included in our investigation- 18 in our pre-intervention cohort, 6 in a roll-out cohort and 21 in our post-intervention cohort. Each cohort was clinically similar. The intervention reduced total post-operative opioid use (morphine equivalents) from 82.2 (mg/kg) to 2.9 (mg/kg) in our post-intervention group (p < 0.0001). Our maximum Neonatal Pain and Agitation Sedation Score over the first 48 post-operative hours were equivalent (p = 0.827). Safety profiles were statistically equivalent. The opioid reduction intervention reduced post-operative intubation length from 156 to 44 h (p = 0.021).

Conclusion

A multi-tiered intervention can decrease opioid use in post-surgical neonates with complex surgical pathology including CDH. The intervention proposed in this investigation is safe and does not increase pain or sedation scores in neonates, while lessening post-operative intubation length.

Evidence level

Level II

中文翻译：

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开放性先天性膈疝修补术后减少新生儿术后阿片类药物的使用：一项质量改进计划

背景

在新生儿人群中实施了数量有限的术后阿片类药物减少策略。鉴于长期使用阿片类药物对神经发育的潜在影响，我们制定了一项质量改进计划，以减少 NICU 中的阿片类药物，并评估了对 CDH 人群的干预。

方法

我们的阿片类药物减少干预基于术后站立静脉注射对乙酰氨基酚，标准化手术、麻醉和 NICU 团队之间的术后退出，以及与 NICU 提供者就术后疼痛控制管理进行的一系列教育研讨会。除了利用过程控制图来调查处方模式的时间趋势之外，还使用历史对照对阿片类药物处方模式进行回顾性队列分析。

结果

我们的调查包括 45 名接受手术的 CDH 儿童——18 名在我们的干预前队列中，6 名在推出队列中，21 名在我们的干预后队列中。每个队列在临床上相似。在我们的干预后组中，干预将术后阿片类药物的总使用量（吗啡当量）从 82.2（mg/kg）降低到 2.9（mg/kg）（p  < 0.0001）。我们在术后前 48 小时内的最大新生儿疼痛和躁动镇静评分相当（p  = 0.827）。安全性概况在统计学上是等效的。阿片类药物减少干预将术后插管时间从 156 小时缩短至 44 小时（p =  0.021）。

结论

多层次的干预可以减少手术后具有复杂手术病理学（包括 CDH）的新生儿的阿片类药物使用。本调查中提出的干预措施是安全的，不会增加新生儿的疼痛或镇静评分，同时缩短术后插管时间。

证据级别

二级