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Acetaminophen >> Opioids in NICU
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Minor Deity
Picture of Axtremus
posted
https://medicalxpress.com/news...-mortality-nicu.html

quote:
Following these changes [switching from opioids to acetate], the number of unplanned intubations decreased more than 75%, resulting in 11 fewer unplanned intubations each year in the NICU. The percentage of infants receiving acetaminophen following surgery increased from 25% to 90%, which resulted in a significant decline in opioid exposure during the post-operative period.

These improvements have been sustained for more than two years, and in addition, the 30-day mortality rate for postoperative patients in the NICU significantly declined from 6.5% to 0.7%, a nearly 90% decrease.


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Posts: 12696 | Registered: 01 December 2006Reply With QuoteReport This Post
Has Achieved Nirvana
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Thumbs up!

I want the emojis to come back.


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Posts: 25722 | Location: Still living at 9000 feet in the High Rockies of Colorado | Registered: 20 April 2005Reply With QuoteReport This Post
Minor Deity
Picture of Mary Anna
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When Muffin's Sister was in the NICU, all oral and intravenous painkillers were considered too dangerous to use on micro-premies like her. Granted, babies her size (1 pound, 10 ounces) were and are a tiny minority, and this study likely included all NICU babies, some of which approach an ordinary birth weight. Without reading the whole thing, I can't know whether any of the babies given opiates or acetaminophen were as small as Muffin's Sister or were born as early.

In 1987, it was thought that babies at her stage of development didn't have nervous systems that were sufficiently developed to feel pain as we understand it, but the truth is that nobody can know what they did feel.

She had surgery that opened her chest with only local anesthesia and a paralytic to keep her still, and this was considered progressive. The care that she received was cutting-edge (and that's a terrible metaphor for this conversation), and I believe that we owe her survival to this. Her doctors told me that most hospitals did the surgery with only the paralytic, but they believed that giving her the local anesthetic was safe enough, even in her fragile condition, and it might even be safer. She was down to 1 pound, 6 ounces at that time, and who could know what the stress of surgery without any anesthesia at all would do to her system?

They also believed that presuming she felt pain and trying to relieve it was the right thing to do.


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Mary Anna Evans
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MaryAnna@ermosworld.com

 
Posts: 15518 | Location: Florida | Registered: 22 April 2005Reply With QuoteReport This Post
Minor Deity
Picture of Mary Anna
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As far as I know, she had no pain relief after the surgery.

If I thought too hard about the painful procedures and needles and blades that were necessary for her survival, I'd probably take to my bed for a day or two. Or to drink.

I feel certain that the conditions of her birth have shaped her in ways that nobody can ever know, not even her.


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Mary Anna Evans
http://www.maryannaevans.com
MaryAnna@ermosworld.com

 
Posts: 15518 | Location: Florida | Registered: 22 April 2005Reply With QuoteReport This Post
knitterati
Beatification Candidate
Picture of AdagioM
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Son1 had bilateral hernia repair at 3.5 months (emergency at Children’s Hospital in Harrisburg PA), 36 years ago. The only pain med given afterwards was acetaminophen. He didn’t seem to mind?


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Posts: 9802 | Location: Oregon | Registered: 06 June 2005Reply With QuoteReport This Post
Minor Deity
Picture of Mary Anna
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I'm glad it went well for him.

Muffin had surgery for an infected cyst at three months. (The docs said it was in the spot where we all have vestigial gills in our necks.)

I believe that was a general anesthesia situation, but I don't recall if anything was prescribed for pain afterward. I was recovering from surgery myself, having had surgery a week before for an ovarian cyst complicated by adhesions and such. I was nursing, so I had to spend the night sitting up in a chair in Muffin's room so that I'd be there for feedings. (And also so that a 3-month-old wouldn't have to spend a night in a strange room, crying and alone.)

The main thing I remember about aftercare was being told that I needed to pack gauze in the wound several times a day so that it would heal properly, but I wasn't actually taught how to do that. I came home and had a nervous collapse over the whole thing, but my next-door neighbor was a pediatrician and she helped me with the wound-packing.

If I had to guess, I'd say there were no after-surgery painkillers beyond Tylenol, but things went okay.


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Mary Anna Evans
http://www.maryannaevans.com
MaryAnna@ermosworld.com

 
Posts: 15518 | Location: Florida | Registered: 22 April 2005Reply With QuoteReport This Post
(self-titled) semi-posting lurker
Minor Deity
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MA and Adagio, what terrifying experiences!!

So glad things worked out though! Whew!


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Posts: 18581 | Location: not in Japan any more | Registered: 20 April 2005Reply With QuoteReport This Post
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