A Post-Operative Pain Management Guideline for Opioid Exposed Neonates

Background:Neonates are commonly prescribed opioids in the NICU for pain management. Prolonged opiate exposure can lead to increased drug tolerance and/or dependence, and result in higher total opiate exposure and suboptimal pain control. Evidence suggests that the use of a standardized pain management guideline can decrease provider opioid prescribing variability and lead to improved pain management. The objective of this project was to develop, pilot, and evaluate a standardized post-operative pain management guideline for the opioid exposed neonatal population. Methods: Criteria to categorize patients as "opioid exposed" was determined after completing a literature review and consulting with content experts. A retrospective chart review of 20 patients was completed to assess baseline opioid exposure and post-operative pain control. An evidence based guideline was developed to be trialed and implemented for "opioid exposed" neonates to improve post-operative pain control. Education regarding the guideline was provided to staff prior to the implementation. Following the trial of the guideline, a review of four charts was conducted to evaluate the use and adherence to the new guideline and to compare total opiate exposure and time to achieve pain control post-operatively before and after piloting the guideline. Results:Total opioid exposure between the two groups was compared using descriptive statistics due to the small sample size of pilot patients. Results showed that the total mean opioid exposure and time to achieve pain control post-operatively decreased in the post-implementation group. However, total benzodiazepine and total dexmedetomidine exposure increased in the post-implementation group. Conclusions:Piloting an evidence-based guideline to standardize post-operative pain management for opioid exposed neonates resulted in a decrease in opioid exposure and time to achieve pain control post-operatively. Further studies with larger sample sizes are recommended in order to gain further knowledge on how to appropriately and effectively manage post-operative pain for opioid exposed neonates.