Use of patient-controlled analgesia for pain control in dying children

Schießl, Christine; Gravou, Chara; Zernikow, Boris; Sittl, Reinhard; Grießinger, Norbert

doi:10.1007/s00520-008-0408-2

Cited by 25 publications

(30 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Breakthrough cancer pain in children is usually of sudden onset, severe, and of short duration (Friedrichsdorf et al, 2007 Level IV). Pain and opioid requirements may escalate in terminal stages of cancer, and benefit has been reported with use of PCA opioids to allow rapid dose titration (Schiessl et al, 2008 Level IV) and with addition of ketamine (Finkel et al, 2007 Level IV).…”

Section: Cancer-related Painmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

View full text Add to dashboard Cite

Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

show abstract

Section: Cancer-related Painmentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

View full text Add to dashboard Cite

show abstract

“…Its use is valuable for pediatric cancer patients to relieve severe pain and provide better quality of life. [1–3] PCA by proxy is authorized opioid boosting by someone other than the patient, such as a health care provider or a parent for pediatric patients; this practice is safe [4–6] and is associated with high satisfaction and good compliance. [7]…”

Section: Introductionmentioning

confidence: 99%

The Safety and Effectiveness of Patient-controlled Analgesia in Outpatient Children and Young Adults With Cancer

Anghelescu

Zhang²,

Faughnan³

et al. 2015

Journal of Pediatric Hematology/Oncology

View full text Add to dashboard Cite

Background Patient-controlled analgesia (PCA) is safe and effective in hospitalized children; however, data regarding its use for outpatients are limited. The aims of the study are to determine the safety of outpatient PCA and to compare the standard and proxy PCA groups. Methods All patients receiving outpatient PCA over 54 months were included in this retrospective study. Data regarding age, sex, diagnosis, PCA initiation/discontinuation circumstances, patient vs. proxy-authorized PCA type, opioid doses, pain scores, and complications were collected. Nonparametric tests (Wilcoxon-Mann-Whitney test for comparing two groups or Kruskal-Wallis rank sum test for comparing more than two groups) were used to compare duration of PCA use, opioid doses, pain scores, and circumstances of initiation and discontinuation of outpatient PCA. Results Forty-five patients used 69 outpatient PCAs. The complication rate was 0.36%. The starting mean MED (mg/kg/day) was 1.67 when initiation was for an outpatient and 4.04 for those discharged from the hospital with PCA; this difference was not statistically significant (p=0.13). The analysis of mean opioid doses in relationship to the circumstances for the discontinuation of the outpatient PCA revealed a significantly higher dose (mg/kg/day) in the group of patients who died (19.54) than in the group with a change of status to inpatient or transfer to another hospital or hospice (3.70) and in the group in which PCA was discontinued because pain management no longer required a PCA (1.19). The mean opioid daily doses and pain scores were significantly higher at the end of life (p<0.0001). Conclusion Outpatient PCA use for children and young adults with cancer is safe.

show abstract

“…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].…”

Section: Zirkadianer Rhythmus Des Pca-gesteuerten Opioidverbrauchs Beunclassified

“…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].…”

Section: Zirkadianer Rhythmus Des Pca-gesteuerten Opioidverbrauchs Beunclassified

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

Schießl

Schestag

Grießinger

et al. 2008

Schmerz

View full text Add to dashboard Cite

PCA seems to be an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose in children with chemotherapy-induced mucositis. This is expressed through the increase in daily self-administered opioid doses after starting PCA, the huge interindividual variability in opioid consumption and the rare event of an un-delivered bolus request during lock-out time. With the use of a background infusion, additional bolus requests are rare during the night.

show abstract

Use of patient-controlled analgesia for pain control in dying children

Abstract: PCA proved an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose to effect.

Cited by 25 publications

References 36 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

The Safety and Effectiveness of Patient-controlled Analgesia in Outpatient Children and Young Adults With Cancer

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

Contact Info

Product

Resources

About