Patient‐controlled analgesia in children

Abstract

Summary We report our experience in introducing patient‐controlled analgesia at the Royal Hospital for Sick Children, Glasgow. Twenty‐five children used the technique after orthopaedic or general surgery using the Graseby system. The pump was loaded with 1 mg/kg morphine sulphate in 50 ml. A bolus dose of 0.02 mg/kg (1 ml) and a lockout interval of 10 minutes were the initial settings. The dose used, pain and sedation scores, respiratory rate and arterial oxygen saturation were recorded. Ages ranged from 5–15 years (mean 9.6) and the method was used for a mean of 48 hours after operation. Morphine requirements averaged 26 (μg/kg)/hour (SD 10.6). Pain control was good and sedation minimal. Adverse effects were few and minor. Education of patients, parents and nurses is essential for its success and safety. The technique is an effective and safe means of providing good quality analgesia in school age children.

Elternkontrollierte Analgesie

“…Auch bei Kindern wird dieses Verfahren mit Erfolg angewandt. Die meisten Autoren empfehlen jedoch ein Mindestalter von 5-6 Jahren [3][4][5][6][7][8][9][10]. Während in einigen älteren Arbeiten erst ab ca.…”

“…Einigkeit besteht bei allen Autoren [5,8,15,18] Im angloamerikanischen Sprachraum ist das meist benutzte Analgetikum Morphin bzw. Morphinsulfat [1,[3][4][5][6][7]19].…”

Assessment and control of pain in children

“…Morphine remains the gold standard opioid for children and may be given by continuous intravenous infusion [29]. Modern electronic pumps allow analgesia infusions under nurse (NCA) [8] or patient control (PCA) [30]. The latter two techniques cope better with differences in the severity of pain between operations, the fluctuating course of postoperatve pain and individual differences in opioid requirements.…”

“…The latter two techniques cope better with differences in the severity of pain between operations, the fluctuating course of postoperatve pain and individual differences in opioid requirements. PCA may be used in children from the age of 5 years [30] but all children require careful pre-operative preparation and postoperative support [8]. Unlike adults, children are optimally managed with a background infusion of 4 pg.kg-'.h-' (bolus doses of 20pg.kg-' plus lockout interval of 5 to 10min) [31].…”

Postoperative Analgesia in Children

“…Patient controlled analgesia (PCA) has been used in children older than 6 yr in both the U.S.A. [12] and the U.K. [13]. background infusion has been shown by some workers to produce no improvement in analgesia [14] and its routine use has been questioned [15].…”