Authors:
S. Riemondy
G.W.
Rung
J. Hershey
T.V.N. Ballantine
Hershey Medical Center, Hershey,
Pennsylvania, USA
The most common treatment of postoperative pain in pediatric patients continues to be the intermittent intramuscular injection of opioids "as needed". Patient controlled analgesia (PCA) pumps offer advantages but are often limited to older patients. Some institutions have advocated parental assistance in the use of PCA pumps for younger patients ("parent controlled analgesia"). This study was conducted to evaluate nurse controlled analgesia (NCA), a new method of pediatric analgesia, in which the nurse uses a PCA pump solely as a means of facilitating timely analgesic administration.
After institutional review board approval and informed consent, pediatric patients aged 5-11 yrs. undergoing major surgery were randomly assigned receive to either PCA (control) or NCA. The pump prescription was the same in both groups. The following parameters were measured: an investigatory's pain score, patient's pain score (Wong/Baker Faces Rating Scale), sedation score, pruritis. nausea, urinary difficulties, oxygen saturation, and morphine requests and consumption.
Eight patients have been studied to date. The mean age of the patients in the study was 8.6 yrs. Surgical procedures were similar. Average pain score of the PCA group (N=5) was 2.2, and NCA group (N=3) 3.7, p=0.018. The average morphine usage was 0.44mg/kg in the PCA group and 0.19 mg/kg in the NCA group, p=0.027. Nausea and vomiting was more common in the PCA group (60% vs 33%).
From these preliminary results, it appears that NCA provides adequate analgesia with few side effects. Patients in the PCA group used more morphine, and reported less pain than those in the NCA group, but also had a higher incidence of nausea. The clinical situation must be considered to determine whether pain relief or avoidance of opioid side effects takes priority. A large number of patients need to be studied to determine significance.
Selected Analgesics (Equianalgesia)
March 15, 2002
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