[Special forms of analgesia: patient-controlled analgesia]

Patient Controlled Analgesia (PCA) has been used by our Department since 1989 in the management of acute pain following major surgery. A total of 120 patients used the PCA pump in our hospital during the past 3 years. Ages varied from 5 to 20 years with an average of 10.5 years. Duration of administration was 1 day to 14 days with an average of 4 days. The morphine dosages fluctuated from 8 microgram/kg/hr to 37 microgram/kg/hr with an average of 17 microgram/kg/hr. During the first 24 hours postoperatively the average amount of morphine used with the PCAS was 36 microgram/kg/hr, which is higher than the usually prescribed dose of 25 microgram/kg/hr in the fixed rate infusions. No major complications occurred. Pain, sedation and other side effects were assessed by the ward nursing staff. Patient, parent and staff acceptance has been high. We conclude that PCA can be successfully managed by any child who understands the concept of pressing the button when there is pain and we feel that PCA has helped solve many of the problems of providing adequate analgesia in children. It is possible that patients on fixed rate morphine infusions were undermedicated during the first post-operative 24 hours.