The safety and efficacy of parent-/nurse-controlled analgesia in patients less than six years of age

Over the past 5 yr, we have treated nonsurgical and postoperative pain in c hildren <6 yr of age by using a patient-controlled analgesia pump to delive r small-dose continuous TV opioid infusions supplemented by parent- and nur se-controlled opioid bolus dosing. We call this technique parent-/nurse-con trolled analgesia (PNCA). Because the safety and efficacy of PNCA have not been previously evaluated, we have undertaken a prospective, l-yr observati onal study to determine patient demographics, effectiveness of analgesia, a nd the incidence of complications (pruritus, vomiting, and respiratory depr ession) 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 +/- 1.7 yr of age and 11 +/- 5 kg, and received a med ian of 4 (range 2-54) days of PNCA therapy. Maximum daily pain scores were less than or equal to 3/10 (objective pain scale) or less than or equal to 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 an d a 15% incidence of vomiting on the first day of treatment. Nine children studied received naloxone, four (1.7%) for treatment of PNCA-related apnea or desaturation. All had improvement in their symptoms after naloxone admin istration.