Comparison of patient-controlled analgesia with and without nighttime morphine infusion following lower extremity surgery in children

Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials

“…Of these, independent review yielded 7 eligible randomized trials (338 patients) for inclusion (Table 1). 8,9,[11][12][13][14][15] Figure 1 illustrates the results of our literature search. Patients' ages ranged from 5 to 20 years, and all Twenty-three subjects were assigned to a third group, IM morphine, which was not included in the analysis.…”

“…Pain scores at 24 hours included 5 trials 8,9,12,13,15 (n = 203) and did not demonstrate a statistically significant difference with the addition of a background infusion (SMD, −0.22; 95% CI, −0.86 to 0.41; Fig. 2B).…”

“…8,9,[11][12][13][14][15] Overall, there was no difference in opioid consumption with PCA bolus plus background infusion (WMD, 2.31; 95% CI, −3.77 to 8.39; Fig. 6).…”

“…[8][9][10][11][12][13][14][15] However, there is considerable variation between studies in terms of dose of opioid, pain measures used, and risk of bias associated with published trials, making it difficult for practitioners to derive clinically useful information from the results. Thus, there is considerable variation in practice in terms of use of background infusion, as well as dose, duration, and type of operation for which a concurrent background IV infusion might be used.…”

Pain Management for the Hospitalized Pediatric Patient

“…A relatively larger ratio of basal rate to bolus dosing is often used for patients with pain caused by cancer, sickle cell disease, or other chronic disease to provide effective analgesia without the need for frequent on-demand boluses. Studies in postoperative patients have shown that patients sleep better with nighttime background infusions, but in some of these studies they also have more frequent but self-limited brief desaturation episodes [90]. Morphine and hydromorphone are the most commonly used opioids for PCA.…”