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Patient-controlled analgesia in children
S C Lawrie1, D W Forbes, T M Akhtar
1Glasgow Royal Infirmary.
Insights
Patient-controlled analgesia (PCA) effectively manages pain in children post-surgery. This method provided good pain control with minimal sedation and few adverse effects in school-aged children.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Care
Background:
- Effective pain management is crucial for pediatric surgical recovery.
- Traditional analgesia methods may have limitations in controlling post-operative pain in children.
- Patient-controlled analgesia (PCA) offers a promising alternative for pediatric pain management.
Purpose of the Study:
- To evaluate the safety and efficacy of patient-controlled analgesia (PCA) in pediatric patients.
- To assess the feasibility of implementing the Graseby PCA system in a pediatric hospital setting.
- To determine optimal dosing and settings for PCA in children undergoing orthopedic or general surgery.
Main Methods:
- A cohort of 25 children (ages 5-15) utilized PCA post-orthopedic or general surgery.
- The Graseby PCA system was programmed with morphine sulfate (1 mg/kg in 50 ml) with specific bolus and lockout parameters.
- Data collected included morphine consumption, pain and sedation scores, respiratory rate, and oxygen saturation.
Main Results:
- Children required an average of 26 mcg/kg/hour of morphine.
- PCA provided good pain control with minimal sedation reported.
- Adverse effects were infrequent and minor, indicating a favorable safety profile.
Conclusions:
- Patient-controlled analgesia (PCA) is an effective and safe method for providing high-quality analgesia in school-aged children after surgery.
- Comprehensive education for patients, parents, and nursing staff is vital for the successful and safe implementation of PCA.
- PCA can significantly improve the post-operative experience for pediatric surgical patients.
Abstract:
We report our experience in introducing patient-controlled analgesia at the Royal Hospital for Sick Children, Glasgow. Twenty-five children used the technique after orthopaedic or general surgery using the Graseby system. The pump was loaded with 1 mg/kg morphine sulphate in 50 ml. A bolus dose of 0.02 mg/kg (1 ml) and a lockout interval of 10 minutes were the initial settings. The dose used, pain and sedation scores, respiratory rate and arterial oxygen saturation were recorded. Ages ranged from 5-15 years (mean 9.6) and the method was used for a mean of 48 hours after operation. Morphine requirements averaged 26 (micrograms/kg)/hour (SD 10.6). Pain control was good and sedation minimal. Adverse effects were few and minor. Education of patients, parents and nurses is essential for its success and safety. The technique is an effective and safe means of providing good quality analgesia in school age children.