2.50
Hdl Handle:
http://hdl.handle.net/10755/157128
Category:
Abstract
Type:
Presentation
Title:
Developing a Post-operative Pain Management Guideline for the Surgical Neonate
Author(s):
LaBrecque, Michelle; Di Coscia, Christina; Bilak, Jennifer
Author Details:
Michelle LaBrecque, Children's Hospital Boston, Boston, Massachusetts, USA, email: michelle.labrecque@childrens.harvard.edu; Christina Di Coscia; Jennifer Bilak
Abstract:
PURPOSE: Approximately 1.4 million neonates and infants have surgery each year in the United States. Although prevention and treatment of pain in this population is universally accepted, strategies used are often inconsistent, suboptimal and potentially harmful. Physiologic immaturity places the neonate at increased risk for analgesic toxicity. Our goal was to develop a guideline for post-operative pain management in the neonate, which optimizes comfort while decreasing the potential for adverse effects. Description: With expanding expertise of neonatal surgery, the volume and complexity of the Neonatal ICU surgical patient continues to grow. Several challenges in neonatal post-operative pain management include inadequate pain management, toxic effects of opioids and withdrawal. A multidisciplinary NICU pain committee was established to address these issues, provide education and act as a resource on and explore new alternatives for pain management. Through an evidenced based review of the literature and communication with experts in neonatal analgesia and surgery, a post-operative pain management guideline was developed. Components of this guideline include individualized pain management plans based on extensiveness of surgical procedure, past pain history and anesthesia received; early and effective pain treatment; use of opioids as the mainstay of therapy; maximal use of adjunctive therapy and regional analgesia when appropriate. Opioid infusions were started immediately on arrival to the ICU, initial doses used were lower than prior standard and titrated more frequently to reach the minimal effective dose. Guideline implementation was achieved through presentations to staff, computer based education module and bedside education. EVALUATION: Effective management of neonatal surgical pain is not only an ethical obligation but improves outcomes. Initial concerns from nursing staff on this change in practice centered on the lower opioid doses used, however, the comfort level of staff has increased as the number of patients have been effectively managed on this new guideline. Overall patients required less opioid administration during the postoperative period and adequate comfort has been achieved. Future directions in this area include implementation of nurse controlled analgesia and use of non-steroidal anti-inflammatory agents as adjuncts to this guideline.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleDeveloping a Post-operative Pain Management Guideline for the Surgical Neonateen_GB
dc.contributor.authorLaBrecque, Michelleen_GB
dc.contributor.authorDi Coscia, Christinaen_GB
dc.contributor.authorBilak, Jenniferen_GB
dc.author.detailsMichelle LaBrecque, Children's Hospital Boston, Boston, Massachusetts, USA, email: michelle.labrecque@childrens.harvard.edu; Christina Di Coscia; Jennifer Bilaken_GB
dc.identifier.urihttp://hdl.handle.net/10755/157128-
dc.description.abstractPURPOSE: Approximately 1.4 million neonates and infants have surgery each year in the United States. Although prevention and treatment of pain in this population is universally accepted, strategies used are often inconsistent, suboptimal and potentially harmful. Physiologic immaturity places the neonate at increased risk for analgesic toxicity. Our goal was to develop a guideline for post-operative pain management in the neonate, which optimizes comfort while decreasing the potential for adverse effects. Description: With expanding expertise of neonatal surgery, the volume and complexity of the Neonatal ICU surgical patient continues to grow. Several challenges in neonatal post-operative pain management include inadequate pain management, toxic effects of opioids and withdrawal. A multidisciplinary NICU pain committee was established to address these issues, provide education and act as a resource on and explore new alternatives for pain management. Through an evidenced based review of the literature and communication with experts in neonatal analgesia and surgery, a post-operative pain management guideline was developed. Components of this guideline include individualized pain management plans based on extensiveness of surgical procedure, past pain history and anesthesia received; early and effective pain treatment; use of opioids as the mainstay of therapy; maximal use of adjunctive therapy and regional analgesia when appropriate. Opioid infusions were started immediately on arrival to the ICU, initial doses used were lower than prior standard and titrated more frequently to reach the minimal effective dose. Guideline implementation was achieved through presentations to staff, computer based education module and bedside education. EVALUATION: Effective management of neonatal surgical pain is not only an ethical obligation but improves outcomes. Initial concerns from nursing staff on this change in practice centered on the lower opioid doses used, however, the comfort level of staff has increased as the number of patients have been effectively managed on this new guideline. Overall patients required less opioid administration during the postoperative period and adequate comfort has been achieved. Future directions in this area include implementation of nurse controlled analgesia and use of non-steroidal anti-inflammatory agents as adjuncts to this guideline.en_GB
dc.date.available2011-10-26T19:26:47Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:26:47Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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