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

Penk, Jamie S. MD; Lefaiver, Cheryl A. PhD; Brady, Colleen M. BSN; Steffensen, Christine M. Pharm D; Wittmayer, Kimberly MS

doi: 10.1097/CCM.0000000000002771
Pediatric Critical Care
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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.

All authors: Department of Pediatrics, Advocate Children’s Hospital, Oak Lawn, IL.

*See also p. 170.

This work was performed at Advocate Children’s Hospital.

All authors disclosed off-label product use of ketorolac in pediatric population under a Food and Drug Administration investigational new drug application.

Address requests for reprints to: Jamie Penk, MD, Department of Pediatrics, Advocate Children’s Hospital, 4440 West 95th Street, Oak Lawn, IL 60453. E-mail: jamiepenk@gmail.com

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