An audit of patient‐controlled analgesia after appendicectomy in children

Abstract

It is feasible that children with uncomplicated appendicitis given intraoperative NSAID can be successfully managed without PCA.

Does Intravenous Acetaminophen Improve Postoperative Pain Control after Laparoscopic Appendectomy for Perforated Appendicitis? A Prospective Randomized Trial

“…16,18,27 In fact, PCAs are currently still being used for postoperative pain management after appendectomies, though current evidence suggests that the need for a PCA may be declining. 28,29 We felt that utilizing PCAs was crucial for providing a background environment to study the impact of scheduled IVA because each patient would have similar background demands and allow for sensitive detection of a difference created by a nonnarcotic analgesic. The alternative, utilizing as needed medications would introduce too much background noise depending on the threshold of the patient, parent, nurse, and house staff for demanding medications.…”

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

“…Below are some suggestions regarding dosing of some of the drugs that may be applicable to the different pain management ladder levels based on the available literature . Table shows dosage suggestions for systemic analgesia, special care must be taken when prescribing opiods in patients with obstructive sleep apnea.…”

A Novel Tool to Predict Postoperative Opioid Need after Laparoscopic Appendectomy in Children: A Step toward Evidence-Based Pain Management

“…6,22 In a retrospective analysis of 649 children undergoing appendectomy by Ousley et al, 94% received intravenous opioids postoperatively. 3 Another U.S.-based study showed 84% of pediatric patients being discharged with a prescription for opioids after laparoscopic appendectomy. 6 The volume of discharged opioid prescriptions is also notable.…”

“…In recent years, there has been a development toward aggressive pain management with liberal opioid adminis-tration in an indiscriminate fashion. 3 This change was due to studies showing a tendency to underestimate postoperative pain leading to inadequate pain management and increased morbidity and mortality. 4,5 However, there is new evidence indicating this more liberal opioid administration might have overshot the target leaving a significant amount of prescribed opioid doses unused.…”