Patient-Controlled Analgesia

Abstract

Patient-controlled analgesia (PCA) is an analgesic technique originally used in adults but now with an established role in paediatric practice. It is well tolerated in children as young as 5 years and has uses in postoperative pain as well as burns, oncology and palliative care. The use of background infusions is more frequent in children and improves efficacy; however, it may increase the occurrence of adverse effects such as nausea and respiratory depression. Monitoring involves measurement of respiratory rate, level of sedation and oxygen saturation. Efficacy is assessed by self-reporting, visual analogue scales, faces pain scales and usage patterns. This is optimally performed both at rest and on movement. The selection of opioid used in PCA is perhaps less critical than the appropriate selection of parameters such as bolus dose, lockout and background infusion rate. Moreover, opioid choice may be based on adverse effect profile rather than efficacy. The concept of PCA continues to be developed in children, with patient-controlled epidural analgesia, subcutaneous PCA and intranasal PCA being recent extensions of the method. There may also be a role for patient-controlled sedation. PCA, when used with adequate monitoring, is a well tolerated technique with high patient and staff acceptance. It can now be regarded as a standard for the delivery of postoperative analgesia in children aged >5 years.

Acute pain management in children

“…Hydromorphone, with a potency 7 times that of morphine is a hydrogenated ketone of morphine and frequently used as an alternative to morphine in children who are intolerant to morphine 37. Although hydromorphone has not been demonstrated to be superior to morphine in terms of analgesic efficacy or side-effect profile, it is frequently chosen in patients with renal problems because it has no active metabolites.…”

Zirkadianer Rhythmus des PCA-gesteuerten Opioidverbrauchs bei Kindern mit chemotherapiebedingter Mukositis

“…Die patientenkontrollierte Analgesie (PCA) mit computergesteuerten Pum pen wird in der Pädiatrie eingesetzt, um Schmerzen nach Operationen, Verbren nungen und Sichelzellkrisen zu behan deln [12,24,25,29,33]. Aktuelle Arbeiten berichten auch über den erfolgreichen Einsatz bei Kindern mit stark fluktuie renden Tumorschmerzen in der Kinder klinik [30] oder am Lebensende zuhau se [32].…”

“…Aktuelle Arbeiten berichten auch über den erfolgreichen Einsatz bei Kindern mit stark fluktuie renden Tumorschmerzen in der Kinder klinik [30] oder am Lebensende zuhau se [32]. Dabei fordern entweder das Kind selbst, die Eltern oder das Pflegepersonal bedarfsgerecht Bolusdosen an [24]. Die "nursecontrolled", "parentcontrolled" oder "PCA by Proxi" ist nicht unumstrit ten, hat sich aber in Studien als genauso si cher und wirksam erwiesen wie die direkt patientenkontrollierte Analgesie, wenn Eltern und Pflegepersonal vor Therapie beginn ausreichend geschult werden [3,17,27,32,34,35].…”

“…Bemerkenswert in unserem Patien tenkollektiv ist der steigende Opioid verbrauch am Beginn der PCAThera [10,24]. Der mediane Anteil der Tagesopioid dosis, der mit Hilfe der PCABolusfunkti on appliziert wird, ist bis dato nicht unter sucht worden.…”

Pain Monitoring Using Heart Rate Variability and Photoplethysmograph-Derived Parameters by Binary Logistic Regression

“…The Joint Commission on Accreditation of Health Care Organizations advocates that pain be considered a vital sign that should be recorded and monitored [6]. For example, in the post-anesthesia care unit and patient-controlled analgesia, pain intensity reveals patients' suffering [7][8][9][10]. If the patient is always in pain and cannot be relieved quickly, the recovery time will be longer.…”