Patient Controlled Analgesia for Vaso-Occlusive Episodes in Children: A Retrospective Study

Area of Science:

• Pediatric Hematology
• Pain Management
• Sickle Cell Disease

Background:

• Sickle cell vaso-occlusive episodes (VOE) are a common cause of hospitalization in children.
• Effective pain management, often utilizing patient-controlled analgesia (PCA), is crucial for managing VOE.
• Understanding PCA administration patterns can optimize pain control and reduce healthcare resource utilization.

Purpose of the Study:

• To describe the administration of patient-controlled analgesia (PCA) in pediatric patients admitted with sickle cell vaso-occlusive episodes (VOE).
• To identify factors associated with PCA adjustments in this patient population.

Main Methods:

• A single-center retrospective study analyzed inpatient hematology admissions for VOE between 2014 and 2020.
• PCA-ratio (bolus dose/continuous IV opioid dose) and time to PCA adjustment were calculated.
• Statistical models assessed associations between patient characteristics, PCA parameters, and PCA adjustments.

Main Results:

• 866 encounters (172 patients) with PCA for VOE were included; mean age was 15.4 years.
• PCA was initiated at a mean of 3.5 hours post-admission, with a mean initial PCA-ratio of 1.7.
• Lower admission pain scores, lower PCA-ratios, longer time to PCA initiation, and absence of ketamine were associated with PCA not requiring adjustment within 6 hours.

Conclusions:

• Pediatric patients with VOE receive opioids and PCA within hours of admission at this institution.
• While no specific PCA-ratio was definitively superior, lower ratios (higher continuous infusion) correlated with fewer PCA adjustments.
• Further prospective studies are warranted to confirm optimal PCA strategies for VOE pain management.