Patient‐controlled analgesia in children. A comparison of two infusion techniques

Abstract

The effectiveness of patient-controlled intravenous morphine with and without a supplementary fixed rate infusion was studied in 40 children after orthopaedic surgery and 40 children after abdominal surgery. The use of a background infusion after orthopaedic surgery, where the majority of children received intra-operative regional blockade, resulted in a higher total dose of morphine (P < 0.05) without evidence of improved analgesia, compared to PCA alone. Children receiving a background infusion after abdominal surgery showed evidence of improved sleeping patterns post-operatively compared with those receiving PCA alone, despite similar overall morphine consumption. There were no episodes of excessive sedation, or respiratory depression with the use of either regimen, and over 90% of the children studied were assessed as experiencing either no pain or mild pain. The suitability and efficacy of patient controlled analgesia for management of post-operative pain for children aged between 5 and 17 years appears to be confirmed. The use of a supplementary background infusion may be of value in children.

Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials

“…Of these, independent review yielded 7 eligible randomized trials (338 patients) for inclusion (Table 1). 8,9,[11][12][13][14][15] Figure 1 illustrates the results of our literature search. Patients' ages ranged from 5 to 20 years, and all Twenty-three subjects were assigned to a third group, IM morphine, which was not included in the analysis.…”

“…The second study reported no difference in the proportion of patients who experienced none, mild, or moderate/severe pain with the addition of a highdose background infusion of morphine at 20 μg/kg/h. 14 …”

“…8,9,[11][12][13][14][15] Overall, there was no difference in opioid consumption with PCA bolus plus background infusion (WMD, 2.31; 95% CI, −3.77 to 8.39; Fig. 6).…”

“…Therefore, additional post hoc subgroup analyses based on trials using different pain scales 14 Recorded hourly as "none," "mild," or "moderate-severe." Reported as percentage of scores in each category for each 24-h period.…”

“…[8][9][10][11][12][13][14][15] However, there is considerable variation between studies in terms of dose of opioid, pain measures used, and risk of bias associated with published trials, making it difficult for practitioners to derive clinically useful information from the results. Thus, there is considerable variation in practice in terms of use of background infusion, as well as dose, duration, and type of operation for which a concurrent background IV infusion might be used.…”