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Use of patient-controlled analgesia for pain control in dying children
Christine Schiessl1, Chara Gravou, Boris Zernikow
1Department of Palliative Medicine, University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany. Cnschiessl@aol.com
Insights
Patient-controlled analgesia (PCA) effectively manages pain in children with cancer, offering a dependable way to tailor opioid doses. This method proved ideal for individual titration, ensuring comfort during palliative care.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Pain Management
Background:
- Opioid dosing in children nearing end-of-life is highly variable.
- Patient-controlled analgesia (PCA) presents a viable option for managing pain in this population.
- Limited scientific data exists on PCA use in pediatric palliative care.
Purpose of the Study:
- To evaluate the efficacy and feasibility of PCA in pediatric palliative cancer care.
- To assess opioid requirements and pain control in children receiving PCA.
Main Methods:
- Retrospective chart review of pediatric cancer patients treated with PCA.
- Data collected over a 7-year period (January 1998 - January 2005).
Main Results:
- Eight children received PCA for a median of 9 days.
- Significant increase in daily opioid dose (morphine equivalent) upon PCA initiation and in the final week of life.
- Low median daily pain scores (0-3 on a 0-10 scale) were maintained throughout treatment.
- PCA parameter adjustments were made to meet individual patient needs, with a median of 7.5-21 delivered bolus requests daily.
Conclusions:
- PCA is an effective, reliable, and feasible method for analgesic administration in pediatric palliative care.
- PCA allows for precise, individualized titration of opioid doses to manage pain effectively.
- The study supports PCA as a valuable tool for optimizing pain management in children with cancer at the end of life.
Background:
In the last week of life, the daily opioid dose in children is highly variable, making the use of patient-controlled analgesia (PCA) a useful therapy option. Scientific data on the use of PCA in paediatric palliative care are rare.
Materials And Methods:
Retrospective chart review over a 7-year period (Jan 1998-Jan 2005) of PCA treated children dying of cancer was used.
Results:
Eight children were on PCA for a median duration of 9 days (range, 1 to 50). The daily median intravenous morphine equivalent dose referenced to body weight increased significantly when PCA was initiated and during the last week of life. In the last week of life, the median daily number of delivered and undelivered bolus requests ranged from 7.5-21 and 0-4.5, respectively. To meet children's individual needs, 39 PCA parametre changes on 22 opportunities were performed. Median daily mean pain scores remained low (range, 0-3; numerical rating scale 0-10) throughout the period.
Conclusion:
PCA proved an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose to effect.
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