Parent/nurse-controlled analgesia for children with developmental delay. Clin J Pain 2008;24(9):817-24
Date
10/22/2008Pubmed ID
18936600DOI
10.1097/AJP.0b013e3181773b69Scopus ID
2-s2.0-56049093445 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
BACKGROUND: Children with developmental delay are often unable to verbalize pain or advocate for themselves owing to cognitive, motor, or verbal limitations, which puts them at increased risk for poor pain assessment and management. Although patient-controlled analgesia has been shown to be safe, effective, and superior to intermittent opioid dosing, not all children can operate patient-controlled analgesia independently. Parent/nurse-controlled analgesia (PNCA) may be an option for these children. However, the safety and efficacy of PNCA have not been thoroughly evaluated and many practitioners are reluctant to use it.
OBJECTIVES: The purpose of this study was to evaluate the outcomes associated with PNCA in pediatric patients with identified developmental delay.
METHODS: A retrospective review of treatment with PNCA was conducted from a convenience sample of charts for 71 children with developmental delay. Data were collected for 72 hours or until the PNCA was discontinued, whichever came first.
RESULTS: Mean pain scores were low, as was the amount of opioid required to keep patients comfortable. Side effects, with the exception of oxygen therapy, were similar to previous studies regarding PNCA. Somnolence and respiratory depression leading to the administration of naloxone occurred in 2.8% of patients, and potential causes were identified.
DISCUSSION: Pain scores, side effects, and adverse events suggest that PNCA may be an effective method of pain control for children with developmental delay. Diligent monitoring and education are crucial to ensure safety.
Author List
Czarnecki ML, Ferrise AS, Jastrowski Mano KE, Garwood MM, Sharp M, Davies H, Weisman SJAuthors
W. Hobart Davies Professor & Chair in the Phychology department at University of Wisconsin - MilwaukeeSteven J. Weisman MD Professor in the Anesthesiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAnalgesia, Patient-Controlled
Analgesics, Opioid
Child
Child, Preschool
Developmental Disabilities
Female
Humans
Hydromorphone
Male
Morphine
Nurses
Pain Measurement
Pain, Postoperative
Parents
Retrospective Studies
Treatment Outcome
