Patient-controlled analgesia in children and adolescents: A randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia

Berde, Charles B.; Lehn, B. M.; Yee, John; Sethna, Navil F.; Russo, Dennis C.

doi:10.1016/s0022-3476(05)82169-9

Cited by 243 publications

(105 citation statements)

References 27 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: 71%

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: 71%

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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“…Several pain assessment tools have been validated for use in children of different ages and may be used clinically to guide the provision of analgesia or in research studies to quantify pain. These tools include the visual analogue scale (VAS) [6], a simple four point self report scale [7], an Objective Pain Score (OPS) based on observations of behaviour [8. Y] and features of facial expression [ …”

mentioning

confidence: 99%

Validation of three paediatric pain scores for use by parents

1996

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SummaryTwtitj-childrcri undergoing gcwcrul surgery and 20 children undergoing otorhinoluryngologicul surgerj. were ,siniultaneou.s!~~ usst~sscd on t w ) ocrusions hj1 (I cloctor trtid u purent using three puiri scoring systems. The pain scoring systems used were the Ohiiwirt~ Puiri Scorc. u , / h r point nutiicricul score uncl u 100 nini i'isuul unulogue scule. There wu.s u high corrchtion b e t w e n the s c o r~s gircn h,v the doctor und hj, the puretits .for all three scoring systems with parents consistetitlv giring slightlji higher

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“…Ağrılı krizlerde özellikle opioidler oral, im ve iv tekrarlayan dozlarda kullanılabilmektedirler. [14][15][16] Farklı çalışmalarda iv olarak sürekli infüzyon ve istek dozunun birlikte kullanımı ağrının azaltılmasın-da diğer yöntemlere göre daha etkin olarak saptanmıştır. [2,3,17] Çalışmamızda da kullanıcıların %87.2'si ağrılı krizde ağrının azaltılmasında HKA yöntemini diğer yöntemlere göre daha etkin bulmuştur.…”

Section: Discussionunclassified

Evaluation of the efficiency of patient controlled analgesia in children with sickle cell anemia from the perspective of health care professionals and parents.

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2016

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ÖzetAmaç: Orak hücreli anemi (OHA) tanılı çocukların ağrılı krizlerinde, hasta kontrollü analjezi (HKA) yöntemi ağrı tedavisinde tercih edilen bir yöntemdir. Bu çalışma ile OHA tanılı çocuklarda iv HKA yöntemini uygulayan sağlık personeli ve ebevenlerin, yöntem hakkındaki düşüncelerinin ve ilaç uygulama tutumlarının değerlendirilmesi amaçlandı. Gereç ve Yöntem: Algoloji Bilim Dalı tarafından iv HKA yöntemi uygulanan OHA tanılı çocuk hastaların ebeveynleri (n=54) ve tedavileri ile ilgilenen sağlık personelleri (doktor, hemşire) (n=32) olmak üzere toplam 86 kişi çalışmaya alındı. Yöntemin etkinliğinin değerlendirilmesi için katılımcılara anket uygulandı. Kullanıcıların HKA yöntemi hakkındaki bilgi düzeyleri, avantaj ve dezavantajları hakkındaki görüşleri sorgulandı. Bulgular: Sağlık personellerinin %65.6'sı (n=21) HKA yönteminin "akut dönemde gerekli" olduğunu düşündüğü saptandı. Ağrının gece ve gündüz daha iyi kontrol edildiğini düşünenlerin oranı %93 (n=80) idi. Ebeveynlerin %83.3'ü (n=45) sağlık personelinin %87.5'i (n=28) yöntemin ilaca ulaşamama korkusunu azalttığını belirtmiş idi. Ağrının yeniden başlama korkusundaki azalma sağlık personeline göre ebeveynlerde daha belirgindi (sırasıyla %37, %9.4) (p<0.05). Bağımlılık ve yüksek doz ilaç endişesi nedeniyle ebeveynlerin %87'sinin (n=47) istek dozunu kullanmak için ağrı şiddetinin artmasını beklediği saptandı.Yöntemin dezavantajı olarak en çok alarmların giderilmesi (%48; n=26) ve tekrar doldurma için beklenilen sürenin (%48; n=26) uzunluğu belirtilmiş idi. Sonuç: Çalışmamızda, OHA'li çocukların ağrılı durumlarında iv HKA yönteminin hem sağlık personelleri hem de ebeveynler tarafından etkili bulunduğu saptandı. Bununla birlikte kullanıcıların ilaç hakkındaki yanlı bilgilerinin yeterli analjezi düzeyine ulaşmayı engelleyebileceği fark edildi. Yöntemin etkinliğinin artırılabilmesi için kullanıcı endişelerinin yanıt bulacağı eğitimlerin düzenlenmesinin gerekli olduğu kanısına varıldı.Anahtar sözcükler: Ağrılı kriz; çocuk hasta; hasta kontrollü analjezi; orak hücre anemisi. SummaryObjectives: This study evaluated the efficacy of patient-controlled analgesia (PCA) used by children with sickle cell anemia (SCA) based on the attitudes of parents and healthcare professionals. Methods: A total of 86 individuals were involved in the study: 54 parents of children with SCA who were receiving treatment and 32 healthcare providers (doctors, nurses). To evaluate the effectiveness of the PCA method, a questionnaire was prepared to determine the level of knowledge of the participants about the PCA method and their perception of its advantages and disadvantages. Results: According to 65.6% (n=21) of the healthcare providers, PCA should be used during acute phase of pain. The great majority of the participants (93%; n=80) thought that pain was effectively controlled both during the day and at night. PCA reduced the fear of unavailability of analgesic drugs in 83.3% (n=45) of parents and in 87.5% (n=28) of healthcare providers. More parents (37%) reported a reduction in the fear o...

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Patient-controlled analgesia in children and adolescents: A randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia

Cited by 243 publications

References 27 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

Validation of three paediatric pain scores for use by parents

Evaluation of the efficiency of patient controlled analgesia in children with sickle cell anemia from the perspective of health care professionals and parents.

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