PCA Use in Pediatric Patients

Dave ARNP · Feb 29, 2004

medline abstracts: pca use in pediatric patients

what's the latest in patient controlled analgesia in pediatric patients? find out in this easy-to-navigate collection of recent medline abstracts compiled by the editors at medscape pharmacotherapy.

comparison of morphine patient-controlled analgesia with and without ketorolac for postoperative analgesia in pediatric orthopedic surgery

sutters ka, shaw ba, gerardi ja, et al

am j orthop. 1999;28:351-8

the purpose of this prospective, randomized, double-blind, placebo-controlled clinical study was to determine whether the administration of intravenous ketorolac, coadministered with morphine patient-controlled analgesia (pca), demonstrates an opioid-sparing effect, provides improved analgesia, and reduces the incidence of opioid-induced side effects in children after orthopedic surgery. the findings of enhanced analgesia with decreased opioid use suggest that coadministration of ketorolac with morphine pca is beneficial for the treatment of pain in children after orthopedic surgery.

patient controlled analgesia in children and adolescents: a randomized controlled trial

peters jw, bandell hoekstra ie, huijer abu-saad h, et al

paediatr anaesth. 1999;9:235-41

in children, patient controlled analgesia (pca) and continuous infusion (ci) of morphine are well established methods of relieving postoperative pain. this study was designed to assess the efficacy of pca plus background infusion (bi) (15 microg x kg(-1) x h(-1) and bolus doses of 15 microg x kg(-1) with a lock-out interval of 10 min) with ci (20 to 40 microg x kg(-1) x h(-1)) in terms of analgesia, morphine needs and side-effects. a stratified randomized controlled trial was carried out. 47 children aged 5-18 years undergoing major elective lower/upper abdominal or spinal surgery were allocated. the magnitude of surgery was assessed by the severity of surgical stress scoring (sss) system. pain was assessed by self-report every three h. side-effects compatible with morphine as well as morphine consumption were recorded. morphine consumption was significantly increased in the pca group compared with the ci group. moreover, morphine consumption was associated with sss, independent of the technique of administration. there were no significant differences between groups in pain scores or in the incidence of side-effects.

children's use of pca following spinal fusion

kotzer am, foster r

orthop nurs. 2000;19:19-27

purpose: the purpose of this study was to examine the effectiveness of patient-controlled analgesia (pca) in relieving postoperative pain for children and adolescents following spinal fusion.

design/sample: a one-group, descriptive design was used with a convenience sample of 93 children (ages 8 to 21 years) who had undergone spinal fusion over a 2-year period.

methods: all of the patients were using pca postoperatively with morphine sulfate, the most common opioid analgesic prescribed for use in the infusion pump. data were collected for the first 4 postoperative days on four outcome variables: use of pca, self-report of pain, observed pain-related behaviors, and satisfaction with pca.

findings: despite aggressive pain management, findings showed that neither children's pain nor their analgesic use diminished significantly over time. children continued to report moderate-to-severe pain over the 4-day measurement period. likewise, children reported their satisfaction with pca for pain relieve as "fair" to "good."

conclusion: the use of high technology and aggressive pharmacologic treatment alone may not be adequate for managing severe pain following spinal fusion. as proposed by the gate control theory, pain stimuli produce not only physiologic, but also psychologic and emotional responses. relief for severe pain, therefore, may require multidimensional therapies that include nonpharmacologic approaches together with precise titration of available pharmacologic agents.

a randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents

cassady jf jr, lederhaas g, cancel dd, et al

reg anesth pain med. 2000;25:246-53

background and objectives: pain and gastrointestinal dysfunction are primary factors that delay recovery after posterior spinal fusion. previous reports suggest that the choice of analgesic management may effect the course of recovery. this prospective, randomized study compared continuous thoracic epidural analgesia and patient-controlled analgesia in the postoperative care of adolescents undergoing posterior spinal fusion for idiopathic scoliosis.

methods: patients between 11 and 18 years of age were randomized to receive continuous thoracic epidural analgesia with bupivacaine-fentanyl (cea, n = 17) or intravenous patient-controlled analgesia with morphine sulfate (n = 16). after surgery under general anesthesia, pain intensity was evaluated using a self-report visual analog scale (vas). postoperative time to resumption of bowel sounds, liquid intake, and side effects were also recorded.

results: there were no significant differences between groups in vas pain scores, side effects, or time to resumption of liquid intake. there was a significant difference (p = .0089) between groups in return of bowel sounds, which occurred earlier in patients receiving cea.

conclusions: continuous epidural analgesia and patient-controlled analgesia are comparably effective and safe after posterior spinal fusion. return of bowel sounds occurred significantly more rapidly in patients receiving cea postoperatively.

patient-controlled analgesia with ketorolac in pediatric surgery

moreno m, castejon fj, palacio ma

j physiol biochem. 2000;56:209-16

our aim was to quantify the analgesic efficiency of the patient-controlled analgesia technique (pca), using ketorolac, in children aged 6-14 undergoing a surgical intervention. we carried out a double-blind test with two randomly selected groups: the pca group comprising patients submitted to intravenous pca, with "bolus on demand" and the standard group, with conventional analgesia dispensed with ketorolac i.v. (0.5 mg/kg/6 hours). evaluation of pain experienced was performed using the hannallah behavioural scale and quantification of the summing of pain intensity. analgesic efficiency was determined by the pain intensity difference (pid) score. evaluation of pain experienced during hour 1 reveals a marked reduction with time for each group; no inter-group differences were found. at hour 6 there were neither intra-group nor inter-group differences. the accumulated pain score revealed a significant reduction in hour 6, with no differences between the two groups. evaluation of the analgesic effect revealed no differences, either intra-group or intergroup, during the experimental period. the sum of the pids revealed significant differences in the standard group between the values for hours 1 and 6. under the experimental conditions described, both techniques were equally effective for pain treatment, but the efficiency was higher for the pca group.