The Safety and Efficacy of Parent-/Nurse-Controlled Analgesia in Patients Less than Six Years of Age

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Abstract
Over the past 5 yr, we have treated nonsurgical and postoperative pain in children ,6 yr of age by using a patient-controlled analgesia pump to deliver small- dose continuous IV opioid infusions supplemented by parent- and nurse-controlled opioid bolus dosing. We call this technique parent-/nurse-controlled analgesia (PNCA). Because the safety and efficacy of PNCA have not been previously evaluated, we have undertaken a prospective, 1-yr observational study to determine pa- tient demographics, effectiveness of analgesia, and the incidence of complications (pruritus, vomiting, and re- spiratory depression) in patients receiving PNCA. Data were collected on 212 children (98 female) who were treated on 240 occasions with PNCA for episodes of pain. Patients averaged 2.3 6 1.7 yr of age and 11 6 5 kg, and received a median of 4 (range 2-54) days of PNCA therapy. Maximum daily pain scores were #3/10 (ob- jective pain scale) or #2/5 (objective or self-report pain scale) in more than 80% of all occasions of PNCA use. PNCA usage was associated with an 8% incidence of pruritus and a 15% incidence of vomiting on the first day of treatment. Nine children studied received nalox- one, four (1.7%) for treatment of PNCA-related apnea or desaturation. All had improvement in their symp- toms after naloxone administration. (Anesth Analg 2000;91:573-9)