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An audit of patient-controlled analgesia after appendicectomy in children
Rowan Ousley1, Laura L Burgoyne1, Nicola R Crowley1
1Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia.
Insights
Children with uncomplicated appendicitis given intraoperative nonsteroidal anti-inflammatory drugs (NSAIDs) can be successfully managed without patient-controlled analgesia (PCA). This study found oral analgesia was effective and satisfactory for this group, suggesting a potential to rationalize PCA use.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- Patient-controlled analgesia (PCA) is a common method for managing post-appendicectomy pain in children.
- Characterizing PCA use is essential for optimizing pain management strategies.
Purpose of the Study:
- To analyze the analgesic patterns of children receiving PCA after appendicectomy.
- To provide data for rationalizing the future application of PCA in pediatric appendicectomy patients.
Main Methods:
- Retrospective audit of 649 pediatric appendicectomy cases over 4 years.
- Analysis of demographics, surgical approach, pathology, analgesia use, pain scores, and PCA duration.
- Prospective audit of uncomplicated appendicitis patients receiving oral analgesia with intraoperative NSAIDs.
Main Results:
- 85% of patients received opioid PCA; 8% received infusions.
- PCA duration was significantly shorter in uncomplicated appendicitis and with intraoperative NSAID use.
- In prospective audit, 38/44 patients with uncomplicated appendicitis managed with oral analgesia required no further opioid intervention, with high parental satisfaction.
Conclusions:
- Children with uncomplicated appendicitis receiving intraoperative NSAIDs can potentially be managed without PCA.
- Oral analgesia appears effective and satisfactory for selected pediatric appendicectomy patients.
- Findings support a more selective approach to PCA use in pediatric appendicectomy.
Background:
Patient-controlled analgesia (PCA) is commonly used after appendicectomy in children.
Aim:
The aim of this study was to characterize the analgesic use of children prescribed PCA after appendicetomy, in order to rationalize future use of this modality.
Methods:
We retrospectively audited all cases of acute appendicitis over a 4-year period in a single pediatric hospital, recording demographics, surgical approach, pathology, analgesia use, pain scores, and duration of PCA. We preplanned subgroup analyses for surgical approach, pathology, and intraoperative nonsteroidal anti-inflammatory drug (NSAID) administration. We subsequently identified a patient subgroup who were unlikely to require PCA and conducted a (2 months) prospective audit of such patients (uncomplicated appendicitis with intraoperative NSAID) having non-PCA (oral) analgesia.
Results:
Of the 649 patients undergoing appendicectomy for acute appendicitis, 85% were prescribed an opioid PCA, 8% received an opioid infusion (younger patients), and 7% received neither PCA nor infusion. Of the 541 bolus only PCA patients, 49% had laparoscopic surgery, 36% had complicated appendicitis, and 49% received intraoperative NSAID (diclofenac). Mean (SD) duration of PCA was shorter with uncomplicated vs complicated appendicitis (21.9 ± 10.7 vs 32.8 ± 21.1 h, P < 0.001, difference in means [95% CI]: 10.9 [7.7-14.1]), and with intraoperative NSAID (23.2 ± 14.4 vs 28.4 ± 17.4 h, P < 0.001, difference in means [95% CI]: 5.2 [2.5-7.9]). There was no difference in the time to PCA cessation between laparoscopic and open approach. Morphine consumption and pain scores were lower in the early postoperative period for those patients receiving intraoperative NSAID. In the prospective audit, 44 of 69 patients had uncomplicated appendicitis. Thirty-eight of these were prescribed oral analgesia and none required any parenteral opioid or acute pain service intervention postoperatively. Parental satisfaction level was high (>90%) with oral analgesia.
Conclusions:
It is feasible that children with uncomplicated appendicitis given intraoperative NSAID can be successfully managed without PCA.
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