Related Experiment Videos
Patient-controlled analgesia with low dose background infusions after lower abdominal surgery in children
E Doyle1, I Harper, N S Morton
1Department of Anaesthesia, Royal Hospital for Sick Children, Yorkhill, Glasgow.
Insights
A background infusion of 4 micrograms kg-1 h-1 morphine in patient-controlled analgesia (PCA) for children undergoing appendicectomy improved sleep and reduced hypoxemia without increasing side effects.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Patient-controlled analgesia (PCA) is a common method for managing post-operative pain in children.
- Optimizing PCA regimens, including the use of background infusions, is crucial for improving patient outcomes.
- Morphine is frequently used in PCA for pediatric surgical pain.
Purpose of the Study:
- To evaluate the impact of different background infusion rates of morphine in PCA on pain control, side effects, and physiological parameters in children undergoing appendicectomy.
- To compare a 4 micrograms kg-1 h-1 (B4) and 10 micrograms kg-1 h-1 (B10) background infusion rate against no background infusion (B0).
Main Methods:
- A randomized controlled trial involving 45 children (aged 6-12 years) undergoing appendicectomy.
- Three PCA morphine regimens were administered: no background infusion (B0), 4 micrograms kg-1 h-1 (B4), and 10 micrograms kg-1 h-1 (B10).
- Morphine consumption, pain scores, sedation, hypoxemia, nausea/vomiting, and sleep patterns were assessed.
Main Results:
- Total morphine consumption was higher in the B10 group compared to B0 and B4 groups.
- The B4 group experienced less hypoxemia than B0 and B10 groups.
- The B10 group had more nausea and vomiting; however, the B4 group showed no significant difference compared to B0.
- Both B4 and B10 groups had improved nighttime sleep compared to B0.
Conclusions:
- A background infusion of 4 micrograms kg-1 h-1 morphine in pediatric PCA is safe and effective for appendicectomy pain.
- This regimen reduces hypoxemia and improves sleep patterns without increasing side effects like nausea, vomiting, or sedation.
- Optimizing PCA with a low-dose background infusion can enhance recovery in pediatric surgical patients.
Abstract:
Forty-five children (aged 6-12 yr) undergoing appendicectomy received one of three analgesic regimens using patient-controlled analgesia (PCA) with morphine: no background infusion (BO); background infusion 4 micrograms kg-1 h-1 (B4); background infusion 10 micrograms kg-1 h-1 (B10). Total consumption of morphine was greater in group B10 compared with groups B0 (P < 0.01) and B4 (P < 0.05). There was no significant difference in morphine consumption in groups B0 and B4. All three groups self-administered similar amounts of morphine and there were no significant differences in pain scores or incidence of excessive sedation. Group B4 suffered less hypoxaemia compared with groups B0 (P < 0.01) and B10 (P < 0.001). Group B10 suffered more nausea and vomiting than groups B0 (P < 0.001) and B4 (P < 0.001), but there was no significant difference in the incidence of nausea and vomiting between groups B0 and B4. Groups B4 and B10 spent more time at night asleep than group B0 (P < 0.05). There were no significant differences between the groups in the amount of time spent asleep during the day. Inclusion of a background infusion of morphine 4 micrograms kg-1 h-1 in a PCA regimen for children did not increase the incidence of side effects and was associated with less hypoxaemia and a better sleep pattern than no background infusion.