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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Patient-controlled analgesia for children at home
Martha F Mherekumombe1, John J Collins1
1The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Insights
Patient-controlled analgesia (PCA) using a Computerized Ambulatory Drug Delivery (CADD) device effectively manages pain in children with advanced cancer at home. This approach allows for dose adjustments and opioid switches without adverse events, improving end-of-life care.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Pain Management
Background:
- Pain is a prevalent and significant symptom in children with advanced malignant diseases.
- Limited research exists on home-based pain management for these pediatric patients.
Purpose of the Study:
- To describe and review the indications for using patient-controlled analgesia (PCA) via a Computerized Ambulatory Drug Delivery (CADD) device in the home setting.
- To evaluate the safety and efficacy of CADD-based PCA for pediatric cancer pain at home.
Main Methods:
- A retrospective chart review of children discharged home with opioid infusions using a CADD.
- Analysis of charts from January 2008 to February 2012.
Main Results:
- 37 CADDs were dispensed, with 33 for cancer-related pain.
- PCA CADDs were primarily used for end-of-life care, with hydromorphone being the most common opioid.
- Pain control was achieved through dose adjustments or opioid switching with adjuvant therapy; 16 patients were readmitted, 3 for pain.
Conclusions:
- Patient-controlled analgesia (PCA) with a CADD is a viable option for managing pediatric cancer pain at home.
- Dose adjustments and opioid switches were safely managed, indicating the feasibility of home-based CADD use.
Context:
Pain is a common and significant symptom experienced by children with advanced malignant disease. There is limited research on pain management of these children at home.
Objectives:
To describe and review the indications for using patient-controlled analgesia (PCA) in the form of a Computerized Ambulatory Drug Delivery device (CADD(®)) in the home setting.
Methods:
A retrospective chart review was conducted in children discharged home with opioid infusions using a CADD. Charts from January 2008 to February 2012 were surveyed.
Results:
Thirty-seven CADDs were dispensed during the study period, and of these, 33 were prescribed for patients with cancer-related pain. A third of the CADDs were commenced at home and almost all PCA CADDs were used for end-of-life care. Hydromorphone was the most commonly prescribed opioid. Patients remained at home and pain control was achieved by either increasing the opioid dose or switching the opioid and using adjuvant therapy. Sixteen patients were readmitted to hospital from home and three admissions were related to pain. The median duration on a PCA CADD at home was 33.7 days (range, 1-150 days), and the mean morphine equivalent dose was 2.13 mg/kg/day.
Conclusion:
PCA with a CADD can be used to manage pain in the home setting. Dose adjustments and opioid switches were performed with no adverse incidents.
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