[Postoperative pain relief for a patient with elective mutism by patient controlled analgesia]

We previously reported that intrathecal (i.t.) administration of morphine reduced postoperative pain in pediatric patients after spinal instrumentation for scoliosis (Cotrel-Dubousset method), and the i.t. administration of morphine before incision produced better pain relief than that given after the surgical procedure. In this study, we evaluated postoperative pain relief in a patient with elective mutism who had been given i.t. morphine 0.15 mg before surgery. The patient was scheduled to undergo patient controlled analgesia (PCA) intravenously with morphine after surgery. The grade of postoperative pain and incidence of side effects were assessed at 1, 2, 6, 12, 24, and 48 h after the operation. The pain was rated by means of a verbal numeric rating scale (0-3) and a visual analog scale (VAS) (0-100mm). The used morphine volume shown on a PCA device was evaluated at scheduled times. No patient developed hemodynamic instability or respiratory depression during the monitoring period. We conclude that PCA can be useful for the patient with elective mutism.