A double‐blind comparison of morphine infusion and patient controlled analgesia in children

Bray, R. J.; Woodhams, A.M.; Vallis, C.J.; Kelly, Peter; Platt, Martin Ward

doi:10.1111/j.1460-9592.1996.tb00374.x

Cited by 37 publications

(22 citation statements)

References 23 publications

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“…Furthermore, patients in the PCA-group appeared to accept a pain score of 5.5 and did not titrate to achieve a pain-free state, while most health professionals titrate pain medication to reduce even mild pain. This was observed in previous studies in children as well as adults [25][26][27]. The analgesia-induced side effects, as perceived by the patient, may be an important reason for this phenomenon.…”

Section: Side Effects and Adverse Eventssupporting

confidence: 56%

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

et al. 2007

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Intravenous morphine is the treatment of choice for severe pain during vaso‐ occlusive crisis in sickle cell disease (SCD). However, side effects of morphine may hamper effective treatment, and high plasma levels of morphine are associated with severe complications such as acute chest syndrome. Furthermore, adequate dosing remains a problem since no objective measurement of pain severity exists and analgesia should be titrated upon the patient's reported pain. Patient‐controlled analgesia (PCA) may therefore be an interesting alternative since patients can titrate the level of analgesia themselves. In this randomized controlled study, the efficacy of intravenous morphine administration with PCA was compared with continuous infusion (CI) of morphine in patients with SCD during vaso‐occlusive crisis. Twenty five consecutive episodes of vaso‐occlusive crisis in 19 patients with SCD were included in the study. Patients in the PCA‐group had a markedly and significant lower mean and cumulative morphine consumption when compared with the patients in the CI‐group (0.5 mg/hr versus 2.4 mg/hr (P < 0.001) and 33 mg versus 260 mg (P = 0.018, respectively). The mean daily pain scores were comparable (4.9 versus 5.3). The lower mean and cumulative morphine consumption in the PCA‐group led to significant less nausea and constipation during treatment when compared with the CI‐group (area under the curve, respectively, 11 versus 18 (P = 0.045) and 30 versus 45 (P = 0.021). Furthermore, a nonsignificant reduction in the duration of hospital admission of 3 days was observed in the PCA‐group. PCA results in adequate pain relief at a much lower morphine consumption and should considered to be the first choice in morphine administration to sickle cell patients admitted with vaso‐occlusive crisis. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.

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Section: Side Effects and Adverse Eventssupporting

confidence: 56%

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

et al. 2007

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“…However, after the study period, PCA has become increasingly common since it has been shown to have advantages compared with continuous morphine infusions in older children [20,21]. A PCA advantage is that the required amount of morphine generally is reduced which results in a reduced risk of side-effects.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and adequacy of intravenous morphine infusions in children in a paediatric oncology setting

Flogegård¹,

Ljungman²

2003

Med. Pediatr. Oncol.

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Patients who undergo major tumour surgery require extensive pain management to achieve acceptable post-operative pain relief. The routine of giving both a bolus dose and increasing the morphine dose at breakthrough pain should be encouraged. For the other patients studied, morphine infusions were considered to be adequate, but vomiting, nausea, and constipation might be reduced if prophylactic antiemetics and laxatives were given.

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“…The major advantage of PCA compared to conventional analgesic therapy includes high patient satisfaction with being able to control the pain themselves and the minimal delay between request for analgesia and pain relief [14]. Morphine is the analgesic opioid drug most frequently adopted in this practice [2,3,11,18] even if adverse effects such as nausea, vomiting, constipation, sedation, blood pressure instability, itching, allodynia and hyperalgesia may occur during treatment. Although several strategies may be employed when dealing with these adverse effects, they can be so severe that it is necessary to decrease or withdraw the morphine treatment causing the discomfort because of an inadequate pain management.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of fentanyl administered by patient controlled analgesia in children with cancer pain

Ruggiero

Barone

Liotti

et al. 2006

Support Care Cancer

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A double‐blind comparison of morphine infusion and patient controlled analgesia in children

Cited by 37 publications

References 23 publications

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

Characteristics and adequacy of intravenous morphine infusions in children in a paediatric oncology setting

Safety and efficacy of fentanyl administered by patient controlled analgesia in children with cancer pain

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