Walia Hina, Tumin Dmitry, Wrona Sharon, Martin David, Bhalla Tarun, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
J Pain Res. 2016 Jun 11;9:385-90. doi: 10.2147/JPR.S106960. eCollection 2016.
The management of acute pain presents unique challenges in the younger pediatric population. Although patient-controlled devices are frequently used in patients ≥6 years of age, alternative modes of analgesic delivery are needed in infants.
To examine the safety and efficacy of nurse-controlled analgesia (NCA) in neonates less than 1 year of age.
Data from patients <1 year of age receiving NCA as ordered by the Acute Pain Service at our institution were collected over a 5-year period and reviewed retrospectively. The primary outcomes were activation of the institution's Rapid Response Team (RRT) or Code Blue, signifying severe adverse events. Pain score after NCA initiation was a secondary outcome.
Among 338 girls and 431 boys, the most common opioid used for NCA was fentanyl, followed by morphine and hydromorphone. There were 39 (5%) cases involving RRT or Code Blue activation, of which only one (Code Blue) was activated due to a complication of NCA (apnea). Multivariable logistic regression demonstrated morphine NCA to be associated with greater odds of RRT activation (OR=3.29, 95% CI=1.35, 8.03, P=0.009) compared to fentanyl NCA. There were no statistically significant differences in pain scores after NCA initiation across NCA agents.
NCA is safe in neonates and infants, with comparable efficacy demonstrated for the three agents used. The elevated incidence of RRT activation in patients receiving morphine suggests caution in its use and consideration of alternative agents in this population.
急性疼痛的管理在低龄儿科人群中存在独特挑战。尽管患者自控装置常用于6岁及以上患者，但婴儿需要其他镇痛给药方式。
研究护士控制镇痛（NCA）在1岁以下新生儿中的安全性和有效性。
收集我院急性疼痛服务部门按医嘱为1岁以下患者实施NCA的5年数据并进行回顾性分析。主要结局是启动医院的快速反应团队（RRT）或蓝色急救代码，这表示严重不良事件。NCA开始后的疼痛评分是次要结局。
在338名女孩和431名男孩中，用于NCA最常用的阿片类药物是芬太尼，其次是吗啡和氢吗啡酮。有39例（5%）涉及RRT或蓝色急救代码启动，其中只有1例（蓝色急救代码）是由于NCA并发症（呼吸暂停）启动的。多变量逻辑回归显示，与芬太尼NCA相比，吗啡NCA与RRT启动的几率更高相关（OR = 3.29，95%CI = 1.35，8.03，P = 0.009）。不同NCA药物开始后疼痛评分无统计学显著差异。
NCA在新生儿和婴儿中是安全的，所使用的三种药物显示出相当的疗效。接受吗啡治疗的患者中RRT启动发生率升高，提示在该人群中使用时应谨慎并考虑使用替代药物。
