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Patient-controlled analgesia in children
P B Gaukroger1, D P Tomkins, J H van der Walt
1Department of Anaesthesia, Adelaide Children's Hospital, Australia.
Insights
Patient-controlled analgesia (PCA) effectively manages pain in children aged six and older after major surgery. This safe method allows young patients to control their own pain relief, with scoliosis surgery patients needing more medication.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Care
Background:
- Effective postoperative pain management is crucial for pediatric recovery.
- Patient-controlled analgesia (PCA) offers a promising approach for managing pain in children.
- Previous research has explored PCA in various pediatric surgical populations.
Purpose of the Study:
- To evaluate the safety and efficacy of patient-controlled analgesia (PCA) in pediatric patients undergoing major surgery.
- To determine morphine requirements and identify factors influencing them in young patients using PCA.
- To assess the feasibility of PCA in children as young as six years old.
Main Methods:
- A study involving forty pediatric patients (ages 6-18) who underwent major orthopedic or general surgery.
- Utilized patient-controlled analgesia (PCA) with morphine for postoperative pain management.
- Monitored morphine consumption and assessed patient understanding and usability of the PCA device.
Main Results:
- PCA was used for an average of 46.2 hours, with overall morphine requirements averaging 40.5 mcg/kg/hr.
- Morphine needs remained consistent between the initial postoperative hours and later periods.
- Children undergoing scoliosis surgery required significantly higher morphine doses compared to other surgical groups.
- Minor issues were reported with PCA use, and children as young as six successfully utilized the system.
Conclusions:
- Patient-controlled analgesia (PCA) is a safe and suitable method for postoperative pain relief in pediatric patients.
- The ability to understand the PCA concept, rather than a specific age, determines the lower limit for its use.
- PCA empowers pediatric patients, contributing to effective pain management and potentially improved recovery outcomes.
Abstract:
The use of patient-controlled analgesia is described for forty children who had undergone major orthopaedic or general surgery. Ages ranged from 6 to 18 years (mean 11.4 years) and PCA was used for an average of 46.2 hours postoperatively. Morphine requirements overall averaged 40.5 micrograms/kg/hr (SD 22.6). Requirements for the first six hours were not significantly different to a similar period 24 hours later. There was a large individual variation for patients undergoing similar procedures. Patients undergoing scoliosis surgery required significantly more morphine than any other group of patients. Problems with patient-controlled analgesia have been of a minor nature. We conclude that patient-controlled analgesia is a suitable and safe method of pain relief for paediatric patients and that the lower age limit is that at which a child can understand the concept after suitable explanation. In this study children as young as six years were able to successfully use the method.