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Updated: Feb 19, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Parent/Nurse-Controlled Analgesia Compared with Intravenous PRN Opioids for Postsurgical Pain Management in Children
Michelle L Czarnecki1, Keri R Hainsworth1,2, Pippa M Simpson3,4
1Jane B. Pettit Pain and Headache Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Insights
Parent/nurse-controlled analgesia (PNCA) showed no significant pain management advantage over intravenous (IV) PRN opioids in children with developmental delay post-surgery. Opioid consumption and side effects were similar between groups after the initial 12 hours.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Developmental Disabilities
Background:
- Effective postoperative pain management is crucial for pediatric patients, especially those with developmental delay (DD).
- Parent/nurse-controlled analgesia (PNCA) and intermittent intravenous (IV) PRN opioids are common methods for managing pain in children.
- The optimal method for pain control in children with DD remains an area of investigation.
Purpose of the Study:
- To compare the efficacy and safety of PNCA (with and without a basal infusion) versus IV PRN opioids for postoperative pain in children with DD.
- To evaluate pain scores, opioid consumption, and side effects in these patient groups.
Main Methods:
- A randomized controlled trial involving children with DD requiring IV opioids for at least 24 hours postoperatively.
- Patients were assigned to three groups: PNCA with basal infusion, PNCA without basal infusion, or IV PRN opioids.
- Pain scores, opioid consumption, and side effects were assessed starting 12 hours after anesthesia emergence.
Main Results:
- No significant differences in pain scores (≤3 vs. ≥4) were observed between the three groups.
- PNCA with a basal infusion group consumed more opioids than PNCA without a basal infusion.
- Opioid consumption was similar between PNCA without a basal infusion and IV PRN groups.
- No significant differences in side effects were noted, except for increased supplemental oxygen use in the PNCA group.
Conclusions:
- PNCA does not appear to offer an advantage over IV PRN opioids for pain management in children with DD after the first 12 postoperative hours.
- The choice of analgesia method may not significantly impact pain control or side effects in this population beyond the initial recovery period.
Objectives:
The aim of this study was to conduct a randomized, controlled comparison of outcomes associated with parent/nurse-controlled analgesia (PNCA), with and without a basal (background) opioid infusion, with intravenous (IV) opioids intermittently administered by a nurse on an "as needed" basis (IV PRN) for postoperative pain management in children with developmental delay (DD).
Methods:
Participants included children with DD expected to require IV opioids for at least 24 postoperative hours. Patients were randomized to one of three groups: PNCA with a basal infusion, PNCA without a basal infusion, or IV PRN opioids. Demographics, pain scores, opioid consumption, and frequency of side effects were collected beginning 12 hours after emerging from anesthesia to decrease the impact of anesthetic agents on outcomes.
Results:
The 81 participants (median = 12.0, 9.0-15.0 years) were primarily Caucasian (74%) males (58%), with severe DD (69%) having spinal surgery (41%). The proportion of patients in each group with pain scores ≤3 vs ≥ 4 revealed no between-group differences in any epoch (P = 0.09-0.27). Patients in the PNCA with a basal group consumed significantly more opioid (median = 0.03 mg/kg/h morphine equivalents, 0.02-0.03 mg/kg/h) than the PNCA without a basal infusion. No difference was found between the PNCA without a basal (median = 0.01 mg/kg/h morphine equivalents, 0.00-0.02 mg/kg/h) and the PRN groups (median = 0.01 mg/kg/h morphine equivalents, 0.01-0.02 mg/kg/h). There were no statistically significant differences in side effects, with the exception that more children in the PNCA group required supplemental oxygen (P = 0.05).
Conclusions:
Results suggest there may be no advantage to PNCA over PRN opioids in this patient population after the first 12 postoperative hours with regard to pain scores, opioid consumption, or side effects.
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