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[Patient-controlled analgesia. PCA in a three year old child after traumatic amputation]
G Kerschbaum1, J Altmeppen, W Funk
1Klinik für Anästhesiologie, Klinikum der Universität Regensburg.
Insights
Parent-controlled analgesia (PCA) effectively managed severe pain in a young child after traumatic amputation. This case demonstrates PCA
Area of Science:
- Pediatric Anesthesiology and Pain Management
- Trauma Surgery and Rehabilitation
Background:
- Postoperative pain management in children, especially those younger than five years, presents significant challenges.
- Traditional non-opioid analgesics were insufficient for a 3-year-old boy requiring extensive surgical interventions following traumatic leg amputation.
Observation:
- Parent-controlled analgesia (PCA) using piritramide was initiated four days post-admission.
- A structured monitoring regimen assessed pain, sedation, nausea, vomiting, and piritramide consumption.
- Initial maternal caution with PCA led to under-dosing, but effective use was established by day three, eliminating the need for additional analgesics.
Findings:
- PCA proved safe and effective for long-term pain management in this pediatric trauma case.
- No significant adverse effects like nausea or vomiting were observed.
- Opioid consumption increased over time, potentially due to tolerance and initial maternal apprehension.
Implications:
- This case suggests that PCA can be a viable and safe option for children under five years requiring prolonged postoperative pain relief.
- Successful implementation requires experienced healthcare staff, diligent monitoring, and well-instructed, cooperative parents.
- Further research into long-term PCA use in younger pediatric populations is warranted.
Abstract:
We report the case of a 3-year-old boy, who received long-term parent-controlled analgesia after traumatic amputation of one leg. He underwent surgery 17 times for a period of 25 days. Parent-controlled analgesia was started four days after admission because analgesia with non-opioid analgetics (acetaminophen) proved to be insufficient. The pump was set to a bolus-dose of 23 micrograms kg-1 piritramide (dipidolor) and a lockout interval of 10 minutes. Permitted maximum cumulative dose in four hours was 5 mg piritramide. There was no continuous infusion of opioid. PCA and possible adverse effects were explained to the mother. A monitoring regimen was used to assess efficacy (pain intensity estimated by the mother), adverse effects (sedation score, occurrence of nausea and vomiting) and piritramide consumption. For fear of side effects opioid administration was insufficient in the beginning. After three days the mother used the PCA effectively and no additional analgesic medication was required. Nausea or other side effects were not observed. After seven days opioid consumption nearly doubled. Apart from tolerance, this might have resulted from the mother's caution in the first days. After 17 days the PCA was discontinued. Oral analgetics (tramadol) controlled the pain adequately. Management of postoperative pain in children is difficult and too often insufficient. PCA is a safe and effective method of providing postoperative pain relief. Feasibility was shown in adolescents and, more recently, in children aged five years and over. Only few reports are available describing long term use of PCA in children younger than five years. Our case suggests that PCA may also be used effectively and safely in children younger than five years, if experienced staff, a monitoring regimen and cooperative and well instructed parents are available.
