Children's use of PCA following spinal fusion

The purpose of this study was to examine the effectiveness of patient-controlled analgesia (PCA) in relieving postoperative pain for children and adolescents following spinal fusion.

A one-group, descriptive design was used with a convenience sample of 93 children (ages 8 to 21 years) who had undergone spinal fusion over a 2-year period.

All of the patients were using PCA postoperatively with morphine sulfate, the most common opioid analgesic prescribed for use in the infusion pump. Data were collected for the first 4 postoperative days on four outcome variables: use of PCA, self-report of pain, observed pain-related behaviors, and satisfaction with PCA.

Despite aggressive pain management, findings showed that neither children's pain nor their analgesic use diminished significantly over time. Children continued to report moderate-to-severe pain over the 4-day measurement period. Likewise, children reported their satisfaction with PCA for pain relieve as "fair" to "good."

The use of high technology and aggressive pharmacologic treatment alone may not be adequate for managing severe pain following spinal fusion. As proposed by the Gate Control Theory, pain stimuli produce not only physiologic, but also psychologic and emotional responses. Relief for severe pain, therefore, may require multidimensional therapies that include nonpharmacologic approaches together with precise titration of available pharmacologic agents.