Long‐term patient‐controlled analgesia in children

Abstract

SummaryThree children who received patient-controlled analgesia ,for periods of up to 41 days are described. In each casi> putientcontrolled analgesia allow,ed pain control to be achieved in dificult situations. No patient developed tolerance or clinical signs of dependence. This use qf long-term patient-controlled analgesia warrants ,further evaluation. Key wordsAnalgesia; postoperative, patient-controlled. Surgery; paediatric.Patient-controlled analgesia (PCA) is becoming well accepted in the management of acute pain in adults,' and was described in adolescent',' and pre-ad~lescent~.~ children. However, the reports in children describe only its shortterm use, typically for the management of postoperative pain. Over 300 children aged as young as 5 years have received PCA in our hospital, with encouraging results. Three patients have received 'long-term' PCA.Our method of prescribing PCA has already been described.' We use the Graseby PCAS device with a 60-ml syringe attached to an intravenous line which incorporates a one-way valve. Morphine 1 .0 mg/kg (maximum 60 mg) is made up to 60 ml with saline 0.9%. Initially, demand doses of 1.0 ml are given, with a 5-minute lockout interval. This regimen i s often supplemented with a background infusion of 1.0 ml/hour. The volume of drug used, the quality of analgesia, and any sedation or nausea are assessed each hour by the ward nursing staff. A member of the acute pain service sees the patient at least once daily, and is also available 'on-call' for any after-hours problems. Case histories Case IA previously healthy 12-year-old girl (weight 40 kg) presented at another hospital with a large ischiorectal abscess. After incision and drainage, a large cavity remained that needed frequent packing and dressing changes. She was referred to our hospital 7 days after surgery because inadequate analgesia had made these dressing changes impossible. Analgesia was initially with intravenous pethidine by bolus, but morphine syrup was used subsequently. Neither regimen produced acceptable pain relief; morphine also caused nausea and vomiting.She was taken to the operating theatre after admission for examination under general anaesthesia. This demonstrated an abscess cavity that was slow to heal. PCA was started postoperatively using pethidine, since this had not caused nausea previously. Bolus doses of 10-mg were prescribed, with a 3-minute lockout interval and no background infusion. It was anticipated that this regimen would allow the patient to achieve adequate analgesia rapidly (because of the short lockout interval). Figure 1 shows the pethidine doses administered over successive 4-hour periods before and during 14 successive dressings, over a 9-day period. Severe pain was not reported on any occasion. Nausea was reported on only four out of a total of 216 hourly observations. She presented for further curettage of the abscess cavity 5 months later. She requested PCA, which was provided, and analgesia was excellent for a period of one week while further dressings were applied. ...

Abuse liability of oxycodone as a function of pain and drug use history

“…A number of studies have demonstrated that patients in pain readily self-administer opioids using a patient-controlled analgesia procedure, and some studies suggest that the amount of drug self-administered varies directly with the level of pain being experienced (e.g., Berman et al, 1990; Gil et al, 1990; Graves et al, 1985; Mowbray & Gaukroger, 1990; Parker et al, 1991; Schechter et al, 1988; Sidebotham et al, 1997). Consistent with the clinical data, Zacny and colleagues (1996) reported that when normal, healthy volunteers were given the opportunity to self-administer fentanyl intravenously, drug self-administration was significantly greater in the presence of experimentally induced pain than in the absence of pain (Zacny et al, 1996).…”

Trends in intraoperative pain relief in anesthesized Nigerian pediatric patients: Implications for a developing economy

“…15 The pain relief methods used in the intraoperative period for the study patients were mainly parenteral opioids (573 i.e. 87.9%) and regional blocks mainly caudal blocks (46 i.e.…”

“…[6] In addition, the trend for improved safety of drug administration using computerized systems reduces medical errors in drug administration. [15] The implication ofestablishing the current trend for intraoperative pain relief in pediatric patients is enormous costs in terms of equipment, drugs and facilities to be used. It is however, cost effective as it improves socioeconomic life.…”

Patient-Controlled Analgesia

“…[15,[18][19][20] Several authors [21,22] noted less opioid use with PCA when compared with staff-controlled analgesia for oropharyngeal mucositis. It is common in children and is best managed by parenteral opioid analgesia, often being required for several weeks.…”