Nurse‐controlled analgesia (NCA) following major surgery in 10 000 patients in a children’s hospital

Howard, Richard; Lloyd-Thomas, A.R.; Thomas, Mark; Williams, Donald C.; Saul, Rebecca; Bruce, Elizabeth; Peters, Jeroen

doi:10.1111/j.1460-9592.2009.03242.x

Cited by 95 publications

(94 citation statements)

References 15 publications

(17 reference statements)

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“…Thus, we emphasize that next to PGx, ontogeny is also of importance in this age group. Newborns and infants cannot self-report pain and are more prone to opioid-induced severe adverse events such as respiratory depression (74 ), which stresses the need for a more personalized approach. The neonatal period until infancy is the most interesting in view of the developmental changes that occur in this period.…”

Section: Discussionmentioning

confidence: 99%

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

et al. 2017

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BACKGROUND The use of opioids to alleviate pain is complicated by the risk of severe adverse events and the large variability in dose requirements. Pharmacogenetics (PGx) could possibly be used to tailor pain medication based on an individual's genetic background. Many potential genetic markers have been described, and the importance of genetic predisposition in opioid efficacy and toxicity has been demonstrated in knockout mouse models and human twin studies. Such predictors are especially of value for neonates and young children, in whom the assessment of efficacy or side effects is complicated by the inability of the patient to communicate this properly. The current problem is determining which of the many potential candidates to focus on for clinical implementation. CONTENT We systematically searched publications on PGx for opioids in 5 databases, aiming to identify PGx markers with sufficient robust data and high enough occurrence for potential clinical application. The initial search yielded 4257 unique citations, eventually resulting in 852 relevant articles covering 24 genes. From these genes, we evaluated the evidence and selected the most promising 10 markers: cytochrome P450 family 2 subfamily D member 6 (CYP2D6), cytochrome P450 family 3 subfamily A member 4 (CYP3A4), cytochrome P450 family 3 subfamily A member 5 (CYP3A5), UDP glucuronosyltransferase family 2 member B7 (UGT2B7), ATP binding cassette subfamily B member 1 (ABCB1), ATP binding cassette subfamily C member 3 (ABCC3), solute carrier family 22 member 1 (SLC22A1), opioid receptor kappa 1 (OPRM1), catechol-O-methyltransferase (COMT), and potassium voltage-gated channel subfamily J member 6 (KCNJ6). Treatment guidelines based on genotype are already available only for CYP2D6. SUMMARY The application of PGx in the management of pain with opioids has the potential to improve therapy. We provide a shortlist of 10 genes that are the most promising markers for clinical use in this context.

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Section: Discussionmentioning

confidence: 99%

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

et al. 2017

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“…In a small study of 25 adult patients receiving morphine by patient-controlled analgesia (PCA) for postoperative pain, 40% were reported to have pruritus. 2 Pruritus has been reported to occur in 9% to 77% of pediatric patients receiving continuous morphine infusions, 8,9 with some requiring discontinuation of the infusion because the pruritus was intolerable. 8 Pruritus secondary to morphine by IV infusion is postulated to be mediated centrally via opioid receptors.…”

Section: Introductionmentioning

confidence: 99%

“…2 Pruritus has been reported to occur in 9% to 77% of pediatric patients receiving continuous morphine infusions, 8,9 with some requiring discontinuation of the infusion because the pruritus was intolerable. 8 Pruritus secondary to morphine by IV infusion is postulated to be mediated centrally via opioid receptors. 10,11 Although intradermal injection of morphine causes a local histamine reaction, release of histamine is not believed to be responsible for the itching caused by opioids administered spinally or systemically.…”

Section: Introductionmentioning

confidence: 99%

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Compatibility and Stability of Morphine Sulphate and Naloxone Hydrochloride in 0.9% Sodium Chloride for Injection

Kistner

Ensom

Decarie

et al. 2013

CJHP

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“…Nurse-controlled analgesia (NCA) using a patient-controlled analgesia (PCA) pump according to appropriate pain assessment has been reported to be safe and effective for a wide range of ages and types of surgery in pediatric patients [3,4].…”

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confidence: 99%

Original article. Nurse-controlled analgesia for postoperative pain in pediatric patients: effects on nurses’ attitudes and patient care

et al. 2014

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Background:Because of the limited number of patient-controlled analgesia (PCA) pumps in our developing country, we proposed a technique of modified nurse-controlled analgesia (NCA) to relieve postoperative pain in pediatric patients. Objective: We assessed efficacy, safety, compliance by nurses, and satisfaction including parent satisfaction of a modified NCA protocol compared with fixed-dose analgesia conventionally used for postoperative pain relief in pediatric patients. Methods: A prospective study design was conducted in pediatric patients who underwent major surgery in a university hospital. In the pre-NCA phase, patients received a conventional fixed-dose opioid after surgery. In the NCA phase, nurses could initiate two additional small doses autonomously, as prescribed, if the initial bolus was inadequate. Outcome measures were the number of moderate to severe pain scores, respiratory depression, compliance by nurses, and parent satisfaction. Results: There were 117 and 113 patients in the pre-NCA and NCA phases, respectively. Detection of moderate to severe pain ≥2 episodes in 24 h after surgery was significantly higher in the NCA phase especially in moderate to severe pain procedures. Respiratory depression was not found in either phase. The majority of nurses showed positive attitudes to routine use of a modified NCA protocol. Parent satisfaction was high in both groups. Conclusion:The attitude of nurses toward the modified NCA protocol was positive and it significantly increased detection of episodes of moderate to severe postoperative pain, which accordingly increased patient care and pain relief without severe untoward effects.

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Nurse‐controlled analgesia (NCA) following major surgery in 10 000 patients in a children’s hospital

Cited by 95 publications

References 15 publications

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

Analgesia and Opioids: A Pharmacogenetics Shortlist for Implementation in Clinical Practice

Compatibility and Stability of Morphine Sulphate and Naloxone Hydrochloride in 0.9% Sodium Chloride for Injection

Original article. Nurse-controlled analgesia for postoperative pain in pediatric patients: effects on nurses’ attitudes and patient care

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