Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: A prospective descriptive cohort study

Harrison, Denise; Loughnan, Peter; Manias, Elizabeth; Johnston, Linda

doi:10.1016/j.ijnurstu.2008.11.001

« Previous Next »International Journal of Nursing Studies
Volume 46, Issue 5 , Pages 624-632, May 2009

Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: A prospective descriptive cohort study

Denise Harrison
- School of Nursing, The University of Melbourne, Australia
- Department of Neonatology, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
- Critical Care & Neurosciences, Murdoch Childrens Research Institute, Australia
- Corresponding author at: Centre for Nursing and the Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, 555 University Avenue Toronto, Ontario, Canada M5G 1X8. Tel.: +1 416 946 0674; fax: +1 416 978 8222.
Peter Loughnan
- Department of Neonatology, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
Elizabeth Manias
- School of Nursing, The University of Melbourne, Australia
Linda Johnston
- School of Nursing, The University of Melbourne, Australia
- Department of Neonatology, Royal Children’s Hospital, Melbourne, Australia
- Critical Care & Neurosciences, Murdoch Childrens Research Institute, Australia

Received 25 August 2008; received in revised form 24 October 2008; accepted 4 November 2008.

Abstract

Aim

Describe the utilization of analgesic and sedative medications and documentation of pain scores in a cohort of critically ill infants in a neonatal intensive care unit.

Method

A prospective, longitudinal, cohort study of infants with a predicted length of stay ≥28 days. Dosages and routes of administration of analgesic and sedative medications and documentation of pain scores were collected on a daily basis.

Results

55 infants were enrolled into the study. Oral sucrose was administered to all 55 infants, 51 infants (93%) were administered enteral acetaminophen and 50 (91%) infants were administered morphine during their hospitalization. Sedatives were administered to 42 infants (76%); 36 (65%) were administered chloral hydrate and 32 (58%) were administered intravenous midazolam. With the exception of the first week of admission, when there was highest utilization of opioids and lower use of sucrose, acetaminophen and sedatives, the pattern of administration of analgesic and sedative agents remained relatively constant throughout the hospitalization. Pain scores were documented for 36 (65%) infants during their hospitalisation, however for these 36 infants, pain scores were infrequently recorded.

Conclusion

There was substantial and varied analgesic and sedative use in this cohort of infants, yet infrequent documentation of pain assessment scores. These practices highlight important clinical implications for sick infants requiring careful consideration of pain and distress management.

Keywords: Pain, Infant, Pain assessment, Analgesic, Hypnotic, Sedative, Neonatal intensive care unit