Evaluation of Adjunctive Analgesics to Reduce Pediatric IV Morphine Requirements of Patients Cared for in the Emergency Department

Abstract

Objectives: Pain management in the pediatric population is crucial when providing emergency medical care, as inadequate pain control is a significant cause of morbidity and mortality. The use of adjunctive therapy can potentially decrease opioid requirements, thereby reducing potential opioid related adverse effects. The purpose of this study was to evaluate the use of adjunctive therapy and impact on morphine dose requirements for pediatric pain management in the emergency department (ED). Methods: This study was an IRB approved retrospective review of pediatric patients ages 1 to 18 years, who received intravenous (IV) morphine therapy in the ED. Patients were excluded based on opioid-tolerance (using opioids prior to ED visit), diagnosis of sickle cell disease, and oncologic disorders. Data collection included baseline demographics, medical diagnoses and comorbidities, morphine total dose by weight, type, dose by weight and frequency of adjunctive analgesia agents, and pain scores. Results: The use of adjunctive analgesia in addition to morphine did not reduce the total morphine doses given, repeat morphine dose requirements, admission rates, or length of stay but did increase the time to a repeat dose of morphine. In those patients who received adjunctive analgesia before morphine, we saw a statistically significant decrease in the total amount of morphine received, total morphine doses given, repeat morphine dose requirements, and admission rates. Conclusions: In pediatric patients who require pain management in the ED, adjunctive analgesia should be given before morphine to reduce the amount of morphine required.