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Patient-controlled analgesia pain management for children with sickle cell disease
1East Carolina University School of Medicine, Children's Hospital of Eastern North Carolina, Greenville 27858-4354.
Insights
Patient-controlled analgesia (PCA) offers a safe and effective method for managing severe pain in children with sickle cell disease. PCA demonstrated faster pain relief for some patients compared to traditional methods, leading to high satisfaction among patients, families, and staff.
Area of Science:
- Pediatric Hematology
- Pain Management
- Sickle Cell Disease Treatment
Background:
- Painful episodes are a primary cause of hospitalization for sickle cell disease (SCD) patients, accounting for 60% of admissions.
- Effective pain management strategies for SCD are limited, necessitating exploration of novel approaches.
- Patient-controlled analgesia (PCA) is emerging as a promising method for pain relief.
Purpose of the Study:
- To evaluate the safety and efficacy of patient-controlled analgesia (PCA) for managing severe pain in pediatric sickle cell disease (SCD) patients.
- To compare PCA with conventional fixed-schedule pain management in children with SCD.
- To assess patient, family, and staff satisfaction with PCA.
Main Methods:
- A retrospective study comparing 10 pediatric SCD patients treated with PCA for severe pain to 10 similar patients treated with conventional methods.
- Data collected included hospital stay duration, narcotic tapering time, pain relief onset, and parenteral narcotic duration.
- Patient-controlled analgesia (PCA) involved intravenous administration of analgesics, allowing patients to self-regulate dosage.
Main Results:
- While overall hospital stay and narcotic duration were similar, PCA group showed a trend towards faster pain relief (5/10 vs. 1/10 children within 6 hours, P = .052).
- The total dose of intravenous narcotic therapy (meperidine equivalent) was higher in the PCA group.
- Patients, families, and hospital staff reported higher satisfaction and preference for PCA over conventional management.
Conclusions:
- Patient-controlled analgesia (PCA) is a safe and effective option for managing severe pain in children with sickle cell disease (SCD).
- PCA may lead to quicker pain relief for some patients compared to fixed-schedule analgesia.
- PCA demonstrates significant patient, family, and staff preference, suggesting its value in improving the care experience for pediatric SCD patients.
Abstract:
Painful episodes account for approximately 60% of all hospitalizations of children and adults with sickle cell disease. Limited information is available on managing pain in these individuals. Increasing attention is being focused on new ways to promote pain control. A new, safe, and effective way to achieve pain relief and control is through patient-controlled analgesia (PCA). This report describes our experiences using PCA in children with sickle cell disease. Over an 18-month period, 61 children considered to have severe or intolerable pain (unassociated with infection or organ-related disease) were treated with PCA. The records of 10 children selected randomly from the 61 were examined and compared with those of 10 children also randomly selected who had been treated using a conventional, fixed-schedule approach. Time in the hospital, time until tapering of narcotic, time until pain relief, and duration of parenteral narcotic therapy were similar between the two groups. Total dose of intravenous narcotic therapy (meperidine equivalent in mg/kg) was greater in the PCA group. Five of 10 children using PCA, however, experienced relief within 6 hours compared with 1 of 10 children in the non-PCA group (P = .052). Patients, families, and hospital staff expressed satisfaction and preferred PCA to conventional management when offered a choice.