Patient-controlled analgesia in ongoing pain in children. An open-label prospective study of a standardized technique

Background. - Patient-controlled analgesia (PCA) has been shown to be super ior to a continuous morphine infusion for the treatment of ongoing pain in children over five years of age. Nevertheless, prescription parameters such as the bolus dosage and the possible association of a continuous backgroun d infusion have not yet been standardized. Patients and methods, - Thirty-three children, aged four to 17, hospitalize d in a pediatric hematology ward, benefited from PCA with a standardized pr escription: a bolus dosage of at least 25 mg/kg, without a background infus ion. Morphine consumption, side effects and efficacy on pain relief were fo llowed. Results. - Median of mean morphine consumption was 0.32 mg.kg(-1).d(-1). Me dian of maximal consumption was 0.58 mg.kg(-1).d(-1). Mean duration was nin e days. No important side effects were noted, except in two patients. They presented prolonged constipation and a poor quality of nocturnal sleep, but they also had a major depressive syndrome persisting after resolution of p ain. Efficacy was comparable to a continuous intravenous infusion, and noct urnal sleep was of good quality for 31 children. Conclusion. - This standardized technique of PCA can be used extensively in children over five years of age. It can be used as a reference for further studies. (C) 2000 Editions scientifiques et medicales Elsevier SAS.