Effects of Initial Pain Treatment on Sedation Recovery Time in Pediatric Emergency Care

Abstract

The purpose of this study is to compare the sedation recovery times of children receiving ketamine/midazolam (K/M) versus K/M and initial pain treatment (morphine or meperidine) in pediatric emergency care. Study method was a retrospective cross-sectional study of children receiving K/M for procedural sedation analgesia in an urban children's hospital pediatric emergency department (ED). A uniform data collection form was completed for each child. During an 18-month period, 116 children received K/M for procedural sedation analgesia in the ED. For this study, 80 children met inclusion criteria: 33 patients received K/M only; 32 received K/M and morphine, and 15 received K/M and meperidine. In comparing the K/M only group with the K/M morphine and K/M meperidine groups, the mean ketamine and midazolam doses (mg/kg) were not significantly different. In comparing the recovery times (minutes) for the K/M only group (29.7; SD, 15.7) with the K/M morphine (41.1; SD, 22.4) and K/M meperidine (50.1; SD, 24.9) groups, there was a significant difference for both comparisons (95% confidence interval for difference between 2 means, -20.9 to -1.76 and -32.2 to -8.4, respectively). Sedation (K/M) recovery time is significantly greater for children receiving initial pain treatment (morphine or meperidine). Children receiving meperidine had the longest recovery time. Considering this prolonged recovery time and the unique adverse effects of meperidine compared with morphine, we recommend meperidine not be used for initial ED pain treatment of children.