Resch Joseph C, Graf Shelby, Ghalban Ranad, Chinnakotla Srinath, Fischer Gwenyth
Department of Pediatrics, Division of Critical Care University of Minnesota Minneapolis Minnesota USA.
Department of Pediatrics, Division of Critical Care Michigan State University College of Human Medicine Grand Rapids Michigan USA.
Paediatr Neonatal Pain. 2024 Aug 13;6(4):203-212. doi: 10.1002/pne2.12131. eCollection 2024 Dec.
The opioid crisis has emphasized identification of opioid-sparing analgesics. This study was designed as a prospective trial with retrospective control group to determine feasibility for implementing a high-dose prolonged magnesium sulfate infusion for adjuvant analgesia in the pediatric intensive care unit. Approval was granted for study of children receiving total pancreatectomy with islet cell autotransplantation and liver transplantation ages 3-18 years. Study exclusions were pregnancy, neuromuscular disease, hypersensitivity, preoperative creatinine >1.5 times upper limit normal, arrhythmia or pacemaker presence, and clinician concern. Eleven patients were enrolled between January 2020 and December 2022. Magnesium sulfate bolus (50 mg/kg) followed by intravenous infusion (15 mg/kg/h) was initiated in the operating room and extended postoperatively (maximum 48 h). Serum magnesium levels were monitored serially. To prioritize safety, infusion dose was decreased by 5 mg/kg/h for levels greater than 3.5 mg/dL. Clinical team otherwise followed standard multimodal pain practice. Primary outcome was oral morphine equivalent per kg per day during intensive care course (maximum 7 days). Secondary outcomes focused primarily on magnesium safety, including hemodynamic variables, electrolyte variables, respiratory support, and opioid-related side effects. There were no serious adverse events. Treatment group trended toward slightly higher intravenous fluid requirement (~1 bolus), however no increase in blood product. Treatment and control groups were otherwise comparable in targeted outcomes and overall adverse event profile. Use of a high-dose magnesium sulfate infusion protocol for analgesic postoperative use in select transplant recipients appears feasible for continued optimization of study in the PICU.
阿片类药物危机凸显了寻找阿片类药物替代镇痛剂的重要性。本研究设计为一项前瞻性试验，并设有回顾性对照组，以确定在儿科重症监护病房实施高剂量延长硫酸镁输注作为辅助镇痛的可行性。本研究已获批，纳入年龄在3至18岁之间接受全胰切除术加胰岛细胞自体移植和肝移植的儿童。研究排除标准包括妊娠、神经肌肉疾病、过敏、术前肌酐>正常上限1.5倍、心律失常或存在起搏器以及临床医生的顾虑。2020年1月至2022年12月期间共招募了11名患者。在手术室开始静脉推注硫酸镁（50mg/kg），随后静脉输注（15mg/kg/h），术后继续（最长48小时）。连续监测血清镁水平。为确保安全，当血清镁水平高于3.5mg/dL时，输注剂量每小时降低5mg/kg。临床团队则遵循标准的多模式疼痛治疗方案。主要结局指标是重症监护期间（最长7天）每天每公斤体重的口服吗啡当量。次要结局指标主要关注镁的安全性，包括血流动力学变量、电解质变量、呼吸支持以及与阿片类药物相关的副作用。未发生严重不良事件。治疗组的静脉输液需求量略高（约1次推注），但血液制品使用量未增加。治疗组和对照组在目标结局和总体不良事件方面具有可比性。在特定移植受者中使用高剂量硫酸镁输注方案进行术后镇痛似乎可行，可继续在儿科重症监护病房对该研究进行优化。
