Patient-controlled analgesia for infants and children

Authors

  • D. Simić University Children Hospital, Belgrade, Serbia
  • I. Budić Clinical Centre Nis, Serbia
  • I. Simić University Children Hospital, Belgrade, Serbia
  • Z. Stanković University Children Hospital, Belgrade, Serbia
  • M. Milenović Medical faculty, University of Belgrade, Serbia
  • M. Stević University Children Hospital, Belgrade, Serbia

Keywords:

patients cotrolled analgesia, PCA, children analgesia, pain management

Abstract

Patients cotrolled analgesia (PCA) pump is an analgesic system where the patient is being deliverd a continuous minimal basal infusion of analgesics (mostly opioids), and the patient can delivere himself an additional bolus of drug by pushing the button. PCA pump is used for moderate to severe pain which requires multiple doses of IV analgesia. It is said that as soon as a child can play computer games, he can use and understand the PCA system. PCA allows the patient to have better analgesia with less dose of drugs than when it is used around the clock. During the first 24 hours, low doses of continuous infusions (background) improve the quality of sleep in pediatric patients without increasing side effects PCA is most commonly used on children for analgesia after major surgery, trauma with preserved sensorium, burns, sickle cell disease, malignancy or painful consequences of chemo-therapy (pain due to mucositis) and in some cases of chronic pain. Patients are generally started on a morphine infusion. Opioid switching in children is strongly recommended in the presence of inadequate analgesic effect and intolerable side effects. The usual, safe dose of morphine that provides adequate postoperative analgesia is in pediatric patients 10–30 mcg/kg/h. In pediatric population for PCA, fentanyl continuous infusions (1 mcg/kg per hour) plus fentanyl boluses (1 mcg/kg) can be safely used. The advantage of PCA is that it eliminates the high peaks and low troughs by allowing the patient to press the demand bolus button when they begin to feel pain. Most of them are very satisfied that they have participated in their own pain management. PCA allows safe analgesia in pediatric patients and lowers frequency of side effects. Patient indicates that their pain level is at a level acceptable to them and that they are happy with this method of analgesia.

Downloads

Download data is not yet available.

References

Mather L. The incidence of postoperative pain in children / Mather L., Mackie J. // Pain. – 1983. – 15. – P. 271–82.

Lonnquist P. A. Postoperative analgesia in infants and children / Lonnquist P. A., Morton N. S. // Br J Anaest. – 2005. – 95 (1). – P. 59–68.

Wolf A. Developmentof pain and stress responses / Wolf A. // Proceedings of the 4th European Congress of Paediatric Anaesthesia. – Paris, 1997.

Mather L. The incidence of postoperative pain in children / Mather L., Mackie J. // Pain. – 1983. – 15. – P. 271–82.

Philip H. Sechzer. Expert On Pain and How to Ease It / Philip H. Sechzer. – The New York Times, 2004-10-04.

Bray R. A double-blind comparison of morphine infusion and patient controlled analgesia in children / Bray R., Woodhams A. M. // Paediatr Anaesth. – 1996. – 6. – P. 121–7.

Dunbar P. J. Use of patient controlled analgesia for pain control for children receiving bone marrow transplant / Dunbar P. J., Buckley P., Gavrin J. R. et al. // J Pain Symptom Manage. – 1995. – 10. – P. 604–11.

Karanikolas M. Filos. Case report. Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathic/ischaemic pain in haemodialysis patients: a case series / Karanikolas M., Aretha D., Kiekkas P., Monantera G., Tsolakis I. // J Clin Pharm Ther. – 35 (5). – P. 603–8.

Doyle E. Comparison of patient controlled analgesia in children by IV and SC routes of administration / Doyle E., Morton N. S., McNicol L. R. // Br J Anaesth. – 1994. – 72. – P. 533–6.

Saudan S. Safety and efficacy of patient controlled epidural analgesia following pediatric spinal surgery / Saudan S., Habre W., Ceroni D. et al. // Ped Anest. – 2008. – 18 (2). – P. 132–139.

Christopher L. Efficacy of Postoperative Patient-controlled and Continuous Infusion Epidural Analgesia versus Intravenous Patient-controlled Analgesia with Opioids. A Meta-analysis / Christopher L., Seth R. Cohen, Jeffrey M. Richmanet al. // Anesthesiology. – 2005. – 103. –P. 1079–88.

Hanna M. Epstein. Postoperative Patient-Controlled Analgesia in the Pediatric Cardiac Intensive Care Unit / Hanna M. Epstein. CriticalCareNurse. – 2017. – Vol. 37. – P. 55–61.

Morton N. S. Acute Paediatric Pain Management. A practical Guide / Morton N. S., Saunders W. B. – Harcourt Brace and Company Ltd., 1998. – P 254.

Miller S. Monitoring and Blunting; validation of a questionnaire to assess styles of information seeking under threat / Miller S. // Journal of Personality and Social Psychology. –1987. – 52 (2). – P. 345–353.

Obituaries / Harold Shipman // BMJ. – 2004. – P. 328.

Dept of Health. Harold Shipman’s clinical practice 1974–1998: A clinical audit commissioned by the Chief Medical Officer. – 2001

Mherekumombe M. F. Patient-Controlled Analgesia for Children at Home / Mherekumombe M. F. and Collins J. J. // Journal of Pain and Symptom Management. – 2015. – Vol. 49. – P. 923–7.

Ruggiero A. Safety and efficacy of fentanyl administered by patient controlled analёgesia in children with cancer pain / Ruggiero A., Barone G., Liotti L. et al. // Support Care Cancer. – 2007. – 15 (5). – P. 569–573.

BNF for children. – Published by BMJ Publishing Group Ltd. Tavistock Square, London, 2008. – WC1H 9JP.

Dawson P. Oxford Handbook of Clinical Skills for Children’s and Young People’s Nursing / Dawson P., Cook L., Holliday L., Reddy H. – Oxford University Press, 2012.

Cohen M. R. Patient-Controlled Analgesia: Making It Safer for Patients. Making It Safer for Patients. A continuing education program for pharmacists and nurses / Cohen M. R., Weber R. J., Moss J. – 2006.

Twycross A. Managing Pain in Children / Twycross A., Dowden S., Bruce E. – Wiley – Blackwell, Oxford, 2009.

Anghelescu D. L. Patient Controlled Analgesia at the end of life at a pediatric oncology institution / Anghelescu D. L., Snaman J. M., Trujillo L. et al. // Pediatr Blood Cancer, 2015. – 62. – P. 1237–44.

Schiessl C. Use of patient-controlled analgesia for pain control in dying children / Schiessl C., Gravou C., Zernikow B. et al. // Support Care Cancer. – 2008. –16. – P. 531e536.

Sirkia K. Pain medication during terminal care of children with cancer / Sirkia K., Hovi L., Pouttu J., Saarinen-Pihkala U. M. // J Pain Symptom Manage. – 1998. –15. – P. 220e226.

Downloads

Published

2017-09-01

How to Cite

1.
Simić D, Budić I, Simić I, Stanković Z, Milenović M, Stević M. Patient-controlled analgesia for infants and children. PMJUA [Internet]. 2017 Sep. 1 [cited 2022 Jun. 30];2(3):19-23. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/60

Most read articles by the same author(s)