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Thibault C, Ramsey EZ, Collier H, Shu D, Faerber J, Schwartz E, Chen J, Goldberg DJ, Yehya N, Gardner MM. Gabapentin as a novel adjunct for postoperative irritability after superior cavopulmonary connection operation in children. Cardiol Young 2024:1-7. [PMID: 38699825 DOI: 10.1017/s1047951124024983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Describing our institution's off-label use of gabapentin to treat irritability after superior cavopulmonary connection surgery and its impact on subsequent opiate and benzodiazepine requirements. METHODS This is a single-center retrospective cohort study including infants who underwent superior cavopulmonary connection operation between 2011 and 2019. RESULTS Gabapentin was administered in 74 subjects (74/323, 22.9%) during the observation period, with a median (IQR) starting dose of 5.7 (3.3, 15.0) mg/kg/day and a maximum dose of 10.7 (5.5, 23.4) mg/kg/day. Infants who underwent surgery in 2015-19 were more likely to receive gabapentin compared with those who underwent surgery in 2011-14 (p < 0.0001). Infants prescribed gabapentin were younger at surgery (137 versus 146 days, p = 0.007) and had longer chest tube durations (1.8 versus 0.9 days, p < 0.001), as well as longer postoperative intensive care (5.8 versus 3.1 days, p < 0.0001) and hospital (11.5 versus 7.0 days, p < 0.0001) lengths of stays. The year of surgery was the only predisposing factor associated with gabapentin administration in multivariate analysis. In adjusted linear regression, infants prescribed gabapentin on postoperative day 0-4 (n = 64) had reduced benzodiazepine exposure in the following 3 days (-0.29 mg/kg, 95% CI -0.52 - -0.06, p = 0.01) compared with those not prescribed gabapentin, while no difference was seen in opioid exposure (p = 0.59). CONCLUSIONS Gabapentin was used with increasing frequency during the study period. There was a modest reduction in benzodiazepine requirements associated with gabapentin administration and no reduction in opioid requirements. A randomised controlled trial could better assess gabapentin's benefits postoperatively in children with congenital heart disease.
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Affiliation(s)
- Celine Thibault
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
- Division of Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
| | - E Zachary Ramsey
- Department of Pharmacy Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hailey Collier
- Department of Pharmacy Services, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Di Shu
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
- The Clinical Futures, Research Institute, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer Faerber
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emily Schwartz
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Chen
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Monique M Gardner
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Killian HJ, Deacy A, Edmundson E, Raab L, Schurman JV. If we know better, why don't we do better? A rapid quality improvement project to increase utilization of comfort measures to reduce pain and distress in children in a COVID-19 mass vaccination clinic. J Pediatr Nurs 2024; 76:e93-e100. [PMID: 38307756 DOI: 10.1016/j.pedn.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Many evidence-based tools exist to address pain and distress associated with injections; however, there remains a large gap between the knowledge of these tools and their utilization. Our hospital began a quality improvement (QI) project prior to COVID-19, with the goal of increasing the utilization of Comfort Promise measures during needle procedures. When COVID-19 vaccinations were approved, our mass vaccination clinics provided an opportunity to rapidly increase utilization across the institution. The primary aim was to increase the percentage of comfort measures (CM) offered with COVID-19 vaccinations. METHODS Through this QI project, nurses and other professionals implemented CMs during COVID mass vaccination clinics. Clinics occurred in 3 age-based waves. Waves served as Plan-Do-Study-Act (PDSA) cycles. Families completed post-vaccination surveys to determine what CMs were offered and intention for future use with vaccinations. RESULTS Uptake of CMs (PainEase, ShotBlockers, Comfort Positioning, Alternative Focus, Topical Lidocaine, and Breastfeeding/Sucrose) throughout the waves increased and generally remained stable. CMs also seemed to decrease pain/distress with vaccinations (70.5 to 88.7%), and children/caregivers intended to use some combination for future vaccinations (82.5 to 98.5%). CONCLUSIONS Fast-paced mass vaccination clinics provided an ideal opportunity to significantly increase utilization of CMs. Across age groups CMs yielded high satisfaction and interest in future utilization. Clinic nurses returned to their own sub-specialties and became change agents. IMPLICATIONS If all healthcare providers can work together to achieve consensus while incorporating comfort measures into daily practice, sustained change with incorporation of these evidence-based tools can be achieved. Future directions are discussed.
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Affiliation(s)
- Haley J Killian
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | - Amanda Deacy
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | | | - Lucy Raab
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA.
| | - Jennifer V Schurman
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
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Engelen N, Heindl LM, Oppitz F, Rokohl AC, Schumacher C, Leister N. [Pain therapy in children following ophthalmic surgery]. DIE OPHTHALMOLOGIE 2023; 120:711-716. [PMID: 37326853 DOI: 10.1007/s00347-023-01884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
Pain following eye surgery is often described as being relatively moderate; however, there are also procedures that lead to a pronounced pain experience. Particularly in pediatric patients, pain therapy is often insufficient due to a lack of knowledge and fear of complications. These individual and organizational deficits lead to unnecessary discomfort for children and parents. Each institution providing surgical treatment must have pain management concepts in its portfolio for the appropriate age groups. This includes a child-oriented setting, age-appropriate information, systematic pain assessment, and pain protocols. Pain management should be planned prior to surgery and individually adapted as it progresses. Children have a right to a perioperative course with low stress and pain.
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Affiliation(s)
- Natascha Engelen
- Praxis für Kinderanästhesie, Nürnberg, Deutschland
- Klinik für Anästhesiologie und Intensivmedizin, Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg, Deutschland
| | - Ludwig M Heindl
- Klinik für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität Köln, Köln, Deutschland
| | - Francesca Oppitz
- Divisie Vitale Functies, Wilhelmina Kinderziekenhuis (WKZ), Universitair Medisch Centrum Utrecht, Utrecht, Niederlande
| | - Alexander C Rokohl
- Klinik für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität Köln, Köln, Deutschland
| | - Christine Schumacher
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Uniklinik Köln, Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Nicolas Leister
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Uniklinik Köln, Universität Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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