Opioid Administration for Postoperative Pain in Children With Developmental Delay

Abstract

Introduction: Parent-/nurse-controlled analgesia (PNCA) has been shown to be safe and effective for a variety of pediatric patient populations, yet no studies were found that assessed parent or nurse satisfaction with this opioid delivery system. The purpose of this study was to explore parent and nurse satisfaction and factors influencing satisfaction with three opioid delivery systems: PNCA with and without a basal infusion and intravenous, as needed (PRN) opioids for children with developmental delay.Methods: As part of a randomized controlled trial, parent satisfaction was measured using a modified Parent Total Quality Pain Management Instrument (Foster & Varni, 2002). Nurses were asked to complete an investigator-developed survey each shift.Results: Parents reported high levels of satisfaction regardless of the opioid delivery system, but parents in the PRN group reported longer wait times for medication and wanted more of a say in their child's pain management. PNCA was described by parents as convenient and fast, whereas PRN opioids were described as inconvenient and burdensome for nurses. Nurses' satisfaction was significantly lower for PRN opioids than PNCA owing to significantly longer administration times and less parental involvement.Discussion: To our knowledge, this is the first randomized controlled trial to explore parent and nurse satisfaction with various opioid delivery systems. Whereas all three systems resulted in high levels of parent satisfaction, nurses were more satisfied with PNCA. Adding this element of satisfaction with PNCA to the already established efficacy and safety adds support for the consideration of PNCA for children with developmental delay.

A Pilot Randomized Controlled Trial of Outcomes Associated with Parent-Nurse Controlled Analgesia vs. Continuous Opioid Infusion in the Neonatal Intensive Care Unit

“…Ultimately, we cannot know whether the low PNCA use by parents was related to the amount of time they were present or absent, the education they received, their preference for nurses to be entirely responsible for medication administration, or other causes. Coupled with results of our previous study (Czarnecki et al, 2015), these results call into 1.00 (0.00-2.44) 1.00 (0.00-2.55) 2.28 (1.80-e) COI POD 0 1.67 (0.00-4.42) 2.00 (0.00-3.63) 0.80 (0.00-5.00) POD 1 1.083 (0.00-3.18) 1.41 (0.00-3.67) 0.67 (0.00-3.54) POD 2 1.83 (0.58-3.42) 1.86 (0.70-3.79) 2.00 (0.00-3.071) POD 3…”

“…Parents in both groups underwent a consenting and survey process that clearly conveyed our interest in their infant's pain experience, which in turn may have affected satisfaction ratings. As high parent satisfaction with pain management has been demonstrated in previous studies of various analgesic delivery systems (Choi et al, 2008;Czarnecki et al, 2015;Muthusamy et al, 2010;Twycross & Collis, 2013;Twycross & Finley, 2013), it is not known to what extent parents' awareness of our interest may have contributed to the high satisfaction found in our current study. However, this would not explain the between-group differences in parents' ratings of their satisfaction with their involvement in their infants' care.…”

“…Additionally, consent did not necessarily translate into a willingness to use the PNCA button when randomized to that group. While involvement in their infants' pain management has been shown to be important to parents (Franck et al, 2012;Simons, Franck, & Roberson, 2001) and nurses (Czarnecki et al, 2015), and while parents in the PNCA group were more satisfied with their level of involvement than parents in the COI group, very few parents reported actually activating the PNCA button. Ultimately, we cannot know whether the low PNCA use by parents was related to the amount of time they were present or absent, the education they received, their preference for nurses to be entirely responsible for medication administration, or other causes.…”

“…The authors suggested that future studies should examine ways in which parents can "achieve their desired level of involvement" (p. 45). One of our recent studies examined differences in parent and nurse satisfaction associated with three opioid delivery systems: PNCA with basal, PNCA alone, and IV opioids administered by a nurse on an as-needed (PRN) basis (Czarnecki, Hainsworth, Jacobson, & Weisman, 2015). We demonstrated that parents were highly satisfied with all three methods of opioid delivery, but more parents in the PRN group reported a desire to be more involved.…”

Safety and effectiveness of parent- or nurse-controlled analgesia in neonates: a systematic review

“…21 Studies on the use of P/NCA have demonstrated decreased pain scores, lower opioid dosages, and improved staff and parent satisfaction. 20,22,23 Despite these advantages, many papers advise that P/NCA should be used only if vigilant monitoring and access to intensive care facilities are available due to the possibility of adverse or critical events. 20,24,25 The use of P/NCA in neonates has not been systematically reviewed; therefore, the safety and effectiveness of this method of analgesia for this population are not well established.…”