Patient‐controlled analgesia for children: a review

Abstract

The technique of patient-controlled analgesia (PCA) has recently been applied successfully to suitable paediatric patients. PCA using morphine has been shown to be feasible, efficacious and safe even in children of 5 years of age. Adverse effects are similar to other techniques using opioids. Hypoxaemia and respiratory depression are unusual but a high dependency level of nursing supervision and oxygen saturation monitoring by pulse oximetry are recommended. Developments of the technique include nurse or parent assisted PCA, the use of other opiates such as fentanyl or alfentanil, patientcontrolled variable rate infusion and patient-controlled epidural analgesia. PCA is also a powerful research tool in evaluating objectively other methods of analgesia. It will find an increasing role in paediatric practice for the management of acute and chronic pain as a major component of a comprehensive pain relief service.

Patient-Controlled Analgesia

“…The subcutaneous route can also be used for PCA delivery [53] and may provide some advantages when venous access is difficult or veins are to be preserved, and may be placed conveniently over the upper chest or thigh by individuals unskilled in venous cannulation. A facility exists for the inclusion of a background infusion usually programmable in micrograms (μg)/kg/h.…”

“…[53] Many of these adverse effects can be attenuated by opioid-sparing techniques, e.g. nausea, vomiting, constipation and pruritus.…”

“…[53] Protocols exist for the safe use of opioids in children by a variety of routes. [53] Protocols exist for the safe use of opioids in children by a variety of routes.…”

Managing acute pain in children

“…Patient-controlled analgesia (PCA) - A patient-triggered, computer-controlled, parenteral morphine infusion pump can give good pain control after operations12 , 19 , 20 and has been used successfully in other situations such as sickle-cell crisis 21. PCA may be suitable for children over 5 20.…”

“…PCA may be suitable for children over 5 20. Before the operation a doctor or specialist nurse should explain the machine and make sure that the child understands the protocol and can work the trigger to deliver a bolus dose.…”