Parent/Nurse-controlled Analgesia for Children With Developmental Delay

Czarnecki, Michelle L.; Ferrise, Antonella S.; Mano, Kristen E. Jastrowski; Garwood, Molly Murphy; Sharp, Mickel; Davies, Hobart; Weisman, Steven J.

doi:10.1097/ajp.0b013e3181773b69

Cited by 32 publications

(32 citation statements)

References 20 publications

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“…4 Others have since reported on the safety and efficacy of this technique in specific patient groups. 5–8 More recently, we demonstrated that the rate of complications of PCA by proxy remains low at our institution despite a 4-fold increase in its use. 10 Here we compare the rate of complications in PCA by parent proxy, PCA by clinician (nurse) proxy PCA, and standard (self-administered) PCA to examine the safety of PCA when parents are given authorization to provide doses.…”

Section: Introductionmentioning

confidence: 76%

“…Even the frequency of naloxone administration cannot be directly compared, as some groups report these data per patient and others report it per treatment day. 4,5,7 Further, it must be kept in mind that the selection of standard PCA vs. clinician-proxy PCA vs. parent-proxy PCA is not randomized, and thus selection bias is a confounding factor.…”

Section: Discussionmentioning

confidence: 99%

“…6 This arrangement is appropriately termed parent/nurse controlled-analgesia. 5 It remains unknown whether the risk of PCA by proxy is increased when the parent serves as proxy.…”

Section: Introductionmentioning

confidence: 99%

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Parent-controlled PCA for Pain Management in Pediatric Oncology

Anghelescu

Faughnan

Oakes

et al. 2012

Journal of Pediatric Hematology/Oncology

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Patient-controlled analgesia offers safe and effective pain control for children who can self-administer medication. Some children may not be candidates for PCA unless a proxy can administer doses. The safety of proxy-administered PCA has been studied, but the safety of parent-administered PCA in children with cancer has not been reported. In this study we compare the rate of complications in PCA by parent proxy versus PCA by clinician (nurse) proxy and self-administered PCA. Our pediatric institution's quality improvement database was reviewed for adverse events associated with PCA from 2004 through 2010. Each PCA day was categorized according to patient or proxy authorization. Data from 6,151 PCA observation days were included; 61.3% of these days were standard PCA, 23.5% were parent-proxy PCA, and 15.2% were clinician-proxy PCA days. Mean duration of PCA use was 12.1 days, and mean patient age was 12.3 years. Mean patient age was lower in the clinician-proxy (9.4 years) and parent-proxy (5.1 years) groups, respectively. The complication rate was lowest in the parent proxy group (0.62%). We found that proxy administration of PCA by authorized parents is as safe as clinician administered and standard PCA at our pediatric institution.

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Section: Introductionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Parent-controlled PCA for Pain Management in Pediatric Oncology

Anghelescu

Faughnan

Oakes

et al. 2012

Journal of Pediatric Hematology/Oncology

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“…There have been a number of studies evaluating the safety and the side effects of different opioid infusion techniques in children (3–7), but few have quantified the risks in terms of severity. In a recent retrospective study of 302 opioid naïve children receiving PCA by proxy (PCA‐P) vs PCA, clinically significant adverse effects occurred in 22% and 24% of PCA‐P and PCA groups respectively.…”

Section: Discussionmentioning

confidence: 99%

APA national audit of pediatric opioid infusions

Morton

Errera

2010

Pediatric Anesthesia

101

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Summary Introduction: A prospective audit of neonates, infants, and children receiving opioid infusion techniques managed by pediatric acute pain teams from across the United Kingdom and Eire was undertaken over a period of 17 months. The aim was to determine the incidence, nature, and severity of serious clinical incidents (SCIs) associated with the techniques of continuous opioid infusion, patient‐controlled analgesia, and nurse‐controlled analgesia in patients aged 0–18. Methods: The audit was funded by the Association of Paediatric Anaesthetists (APA) and performed by the acute pain services of 18 centers throughout the United Kingdom. Data were submitted weekly via a web‐based return form designed by the Document Capture Company that documented data on all patients receiving opioid infusions and any SCIs. Eight categories of SCI were identified in advance, and the reported SCIs were graded in terms of severity (Grade 1 (death/permanent harm); Grade 2 (harm but full recovery and resulting in termination of the technique or needing significant intervention); Grade 3 (potential but no actual harm). Data were collected over a period of 17 months (25/06/07‐25/11/08) and stored on a secure server for analysis. Results: Forty‐six SCIs were reported in 10 726 opioid infusion techniques. One Grade 1 incident (1 : 10 726) of cardiac arrest occurred and was associated with aspiration pneumonitis and the underlying neurological condition, neurocutaneous melanosis. Twenty‐eight Grade 2 incidents (1 : 383) were reported of which half were respiratory depression. The seventeen Grade 3 incidents (1 : 631) were all drug errors because of programming or prescribing errors and were all reported by one center. Conclusions: The overall incidence of 1 : 10 000 of serious harm with opioid infusion techniques in children is comparable to the risks with pediatric epidural infusions and central blocks identified by two recent UK national audits (1,2). Avoidable factors were identified including prescription and pump programming errors, use of concurrent sedatives or opioids by different routes and overgenerous dosing in infants. Early respiratory depression in patients with specific risk factors, such as young age, neurodevelopmental, respiratory, or cardiac comorbidities, who are receiving nurse‐controlled analgesia or continuous opioid infusion suggests that closer monitoring for at least 2 h is needed for these cases. As a result of this audit, we can provide parents with better information on relative risks to help the process of informed consent.

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“…The lesser use of the PCA pump might be explained by the difficulty in explaining its concepts to intellectually disabled children. Czarnecki et al have evaluated the safety of postoperative parent/nurse‐controlled analgesia (PNCA) in 71 intellectually disabled children (mean age 10 years) [Czarnecki et al, 2008]. Two patients needed naloxone administration because of respiratory depression or sedation.…”

Section: Pain Treatmentmentioning

confidence: 99%

Pain management in intellectually disabled children: Assessment, treatment, and translational research

Valkenburg

Dijk

Klein

et al. 2010

Dev Disabil Res Revs

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The primary focus of pain research in intellectually disabled individuals is still on pain assessment. Several observational pain assessment scales are available, each with its own characteristics, its own target group and its own validated use. Observational studies report differences in the treatment of intra- and postoperative pain of intellectually disabled children and almost all children with intellectual disability have comorbidities that need to be addressed. The scope of research has started to broaden. In this review we aim to answer the question: Can we integrate validated ways of pain assessment and postoperative pain treatment in intellectually disabled children to develop specific analgesic algorithms? Regrettably there is little knowledge on possible interaction effects and other relevant pharmacological issues. Possible genotype-phenotype associations related to pain in children with Down syndrome have several promises as six possible candidate genes are located on chromosome 21. In conclusion, the pain assessment tools for intellectually disabled children are there. We should now focus on tailoring the pain treatment. To this aim we need to perform pharmacokinetic and pharmacodynamic studies of analgesics and obtain information about the genotype-phenotype relationships for pain. This can lead to the development of specific analgesic algorithms.

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Parent/Nurse-controlled Analgesia for Children With Developmental Delay

Abstract: Pain scores, side effects, and adverse events suggest that PNCA may be an effective method of pain control for children with developmental delay. Diligent monitoring and education are crucial to ensure safety.

Cited by 32 publications

References 20 publications

Parent-controlled PCA for Pain Management in Pediatric Oncology

Parent-controlled PCA for Pain Management in Pediatric Oncology

APA national audit of pediatric opioid infusions

Pain management in intellectually disabled children: Assessment, treatment, and translational research

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