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Postoperative Patient-Controlled Analgesia in the Pediatric Cardiac Intensive Care Unit
1Hanna Epstein is a graduate of the Doctor of Nursing Practice program at the Medical University of South Carolina in Charleston, South Carolina. She is credentialed as a pediatric nurse practitioner and is currently practicing inpatient pediatric palliative care. gardnerh@musc.edu.
Insights
Patient-controlled analgesia (PCA) significantly reduces postoperative pain and opioid consumption in patients aged 10 and older after cardiac surgery. This method proves more effective than traditional as-needed pain medication for improved outcomes.
Area of Science:
- Cardiothoracic Surgery
- Pain Management
- Quality Improvement
Background:
- Uncontrolled postoperative pain is a common challenge in critically ill patients.
- Patient-controlled analgesia (PCA) is recognized as superior to traditional intravenous as-needed dosing for managing pain in older children and adults.
Purpose of the Study:
- To evaluate the effectiveness of PCA in improving pain-related clinical outcomes for patients aged 10 years and older undergoing cardiac surgery.
- To assess PCA as a pain management strategy in this specific patient population.
Main Methods:
- A quality improvement initiative using the plan-do-study-act (PDSA) methodology was implemented.
- Staff and families were educated to support PCA use over traditional as-needed analgesics.
- Retrospective comparison of as-needed medication use and pain scores before and after PCA implementation.
Main Results:
- The cumulative mean pain score (0-10 scale) decreased from 4.14 to 2.8 within 24 hours post-extubation with PCA.
- Mean opioid consumption reduced, with morphine decreasing from 14.98 mg to 13.58 mg and oxycodone from 22.27 mg to 3.33 mg.
Conclusions:
- Standardized PCA is an efficient and effective strategy for managing postoperative pain in patients aged 10 through adulthood.
- PCA leads to reduced medication consumption and lower mean pain scores, indicating improved pain control.
Background:
High rates of uncontrolled pain in critically ill patients remain common. Patient-controlled analgesia is more effective than traditional intravenous as-needed dosing regimens for managing postoperative pain in older children and adults.
Objective:
To determine whether pain-related clinical outcomes in patients from age 10 years to adult following cardiac surgery are improved by using patient-controlled analgesia as a pain management strategy.
Methods:
Using the plan-do-study-act method of quality improvement, a process was instituted to have both staff and patients' families support the use of patient-controlled analgesia postoperatively as opposed to traditional pain control with as-needed analgesics. Use of as-needed medications and pain scores were retrospectively compared from before to after initiation of patient-controlled analgesia.
Results:
The cumulative mean pain score from the time of extubation through the following 24 hours decreased from 4.14 (on a scale from 0 to 10) when strictly as-needed medications were used to 2.8 with patient-controlled analgesia. Further, the mean amount of opioid consumed decreased from 14.98 mg of morphine and 22.27 mg of oxycodone to 13.58 mg of morphine and 3.33 mg of oxycodone after implementation of patient-controlled analgesia.
Conclusions:
Standardized use of patient-controlled analgesia for postoperative pain management in patients 10 years of age through adulthood is efficient and effective, as evidenced by less medication being consumed by patients and lower mean pain scores.
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