Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials

Hayes, Jason; Dowling, Jeremiah J.; Peliowski, Arie; Crawford, Mark W.; Johnston, Bradley C.

doi:10.1213/ane.0000000000001244

Cited by 29 publications

(8 citation statements)

References 32 publications

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“…Some guidelines advise against the use of a background infusion in adults because of the potential for respiratory depression [ 33 – 35 ]. However, background infusion is widely used in children [ 36 ], who are considered to have a lower risk of respiratory depression [ 37 , 38 ]. A study of the efficacy and safety of PCA in patients with AIS [ 14 ] found no difference between PCA alone and PCA with background infusion with regard to the postoperative use of morphine, side effects, or patient satisfaction and concluded that background infusion did not provide clinically significant advantages over intermittent bolus doses of morphine.…”

Section: Methodsmentioning

confidence: 99%

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

et al. 2018

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Posterior spinal fusion for adolescent idiopathic scoliosis is one of the most invasive surgical procedures performed in children and adolescents. Because of the extensive surgical incision and massive tissue trauma, posterior spinal fusion causes severe postoperative pain. Intravenous patient-controlled analgesia with opioids has been the mainstay of postoperative pain management in these patients. However, the use of systemic opioids is sometimes limited by opioid-related side effects, resulting in poor analgesia. To improve pain management while reducing opioid consumption and opioid-related complications, concurrent use of analgesics and analgesic modalities with different mechanisms of action seems to be rational. The efficacy of intrathecal opioids and nonsteroidal anti-inflammatory drugs as components of multimodal analgesia in scoliosis surgery has been well established. However, there is either controversy or insufficient evidence regarding the use of other analgesic methods, such as continuous ketamine infusion, perioperative oral gabapentin, acetaminophen, continuous wound infiltration of local anesthetics, a single dose of systemic dexamethasone, and lidocaine infusion in this patient population. Moreover, appropriate combinations of analgesics have not been established. The aim of this literature review is to provide detailed information of each analgesic technique so that clinicians can make appropriate choices regarding pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.

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Section: Methodsmentioning

confidence: 99%

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

et al. 2018

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“…This finding may be confounded by routine use of continuous respiratory monitoring in the pediatric population . Another meta‐analysis examining randomized controlled studies comparing PCA vs PCA plus background infusion for postoperative children showed no difference in pain scores, opioid consumption, or risk of adverse events at 12 and 24 hours …”

Section: The Use Of Pcamentioning

confidence: 99%

The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Cravero

Agarwal

Berde

et al. 2019

Pediatric Anesthesia

124

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SummaryOpioids have long held a prominent role in the management of perioperative pain in adults and children. Published reports concerning the appropriate, and inappropriate, use of these medications in pediatric patients have appeared in various publications over the last 50 years. For this document, the Society for Pediatric Anesthesia appointed a taskforce to evaluate the available literature and formulate recommendations with respect to the most salient aspects of perioperative opioid administration in children. The recommendations are graded based on the strength of the available evidence, with consensus of the experts applied for those issues where evidence is not available. The goal of the recommendations was to address the most important issues concerning opioid administration to children after surgery, including appropriate assessment of pain, monitoring of patients on opioid therapy, opioid dosing considerations, side effects of opioid treatment, strategies for opioid delivery, and assessment of analgesic efficacy. Regular updates are planned with a re‐release of guidelines every 2 years.

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“…PCIA has the advantages of immediately releasing the drug whenever the patient demands in low doses, short intervals, short duration of effect, and easy titration of opioids. Another one is that PCIA can ease of dose titration and adaptability to patients need to analgesics [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Patient-Controlled Intravenous Analgesia for Advanced Cancer Patients with Pain: A Retrospective Series Study

Peng

Zhang

Guo

et al. 2018

Pain Research and Management

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Objective To compare the efficacy and side effects of patient-controlled intravenous analgesia (PCIA) with hydromorphone, sufentanil, and oxycodone on the management of advanced cancer patients with pain. Methods Patients allocated to receive PCIA between January 2015 and December 2016 were chosen for this study. After reviewing medical records, we verified if hydromorphone, sufentanil, or oxycodone for PCIA could equally provide effective pain relief. A numeric rating scale (NRS) of cancer pain was applied before PCIA, at 4 hours after PCIA, and at the discontinuation of PCIA. Secondary, the incidence of clinical side effects attributed to PCIA was observed. Results A total of 85 medical records were reviewed. PCIA with hydromorphone (n=30), sufentanil (n=34), and oxycodone (n=21) was used for cancer pain management. PCIA successfully improved pain control in 97.6% of the patients. The most common side effects were constipation (11.8%), nausea (8.2%), and sedation (5.9%). Drug addiction, delirium, or respiratory depression associated with PCIA was not reported in this case series study. No significant intergroup difference was observed in NRS at any of the abovementioned time points. There was no significant difference of analgesic effect among the hydromorphone, sufentanil, or oxycodone. Conclusion PCIA provided timely, safe, and satisfactory analgesia for advanced cancer patients with pain and may be useful for titration of opioids, management of severe breakthrough pain, and conversion to oral analgesia. There was no significant difference of analgesic effect and side effect among the hydromorphone, sufentanil, and oxycodone.

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Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials

Abstract: There was no significant difference in outcomes with the addition of an opioid background infusion to PCA bolus doses of opioid. Further high-quality studies are required.

Cited by 29 publications

References 32 publications

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period

Patient-Controlled Intravenous Analgesia for Advanced Cancer Patients with Pain: A Retrospective Series Study

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