PCA said to be effective method for children
Adults have benefited from patient-controlled analgesia (PCA) for years, but anesthesiologists now recognize that PCA is also beneficial for children who are experiencing postoperative surgical pain.
Most outpatient procedures don’t require PCA for pain control, but there are a few procedures for which PCA is a good choice, says Santhanam Suresh, MD, co-director of the Pain Center at Children’s Memorial Hospital in Chicago. The day-surgery procedures for which Suresh typically considers PCA an option are usually considered 23-hour stay procedures, he says. These surgeries include knee arthroscopy, heel and foot surgeries, and urological procedures such as ureter implants. "PCA is wonderful for orthopedic procedures because bone pain is hard to control," says Suresh.
The benefits of PCA for children include immediate relief of pain, as well as a sense of control for the child, says Amber M. Henderson, MD, anesthesiologist at Children’s Healthcare of Atlanta at Scottish Rite. "Children who are undergoing surgery are so dependent on other people, but PCA is one way we can give them some control over their care." Parents also like the idea of not having to wait for a nurse or a physician’s order for additional pain relief, she adds.
Deciding if children can safely administer their own pain medication is not an exact science. Even though the PCA pump is programmed to release a specific dose at any one time and is also programmed not to release more than a certain amount within a predetermined time period, the pain control won’t be effective if the child doesn’t understand how and when to press the button that releases the medication, says Suresh.
"We talk to the child preoperatively and base our decision on that conversation," he says. Anesthesiologists look for evidence that the child is cognitively able to discern and describe pain and is able to understand the use of medication to control pain.
Suresh doesn’t use a specific age as a rule. "The accepted age is around 7 or 8 years old, but I have seen bright 4-year-olds who understood the concepts quite well."
Age 6 is usually the youngest patient Hen-derson will evaluate for PCA, but not all 6-year-olds meet the requirement of understanding self-administration, she says. "Generally, 7or 8 is the age at which any neurologically normal child is able to understand the use of PCA."
Parents like PCA because it means no shots and no waiting for the nurse to provide pain relief, says Suresh. "We do allow parents to administer the PCA medication because they are acutely cognizant that we don’t want too many drugs in the child’s system."
While Children’s Hospital allows parents to administer medication with a PCA pump, parents are not allowed to administer the drug at Child-ren’s Healthcare of Atlanta, says Henderson. "We don’t want parents administering the medication because there is a risk of oversedation," she says. Although the PCA pump is programmed to prevent an overdose of pain medication, parents might administer a dose if the child moans while asleep, she explains. This leads to a groggier-than-normal child, which makes evaluation of the child’s pain and recovery more difficult, she says.
"We would rather have the child wake from the pain and self-administer the medication," she adds. Not only does this method ensure effective pain control, but children tend to use less pain medication than their anxious parents might choose to use for them, Henderson says. If a parent does administer the medication, the PCA pump is removed, she adds.
For more information about pediatric use of PCA, contact:
• Santhanam Suresh, MD, Co-Director of the Pain Control Center at Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614. E-mail: firstname.lastname@example.org.
• Amber M. Henderson MD, Anesthesiologist, Children’s Healthcare of Atlanta at Scottish Rite, 1001 Johnson Ferry Road N.E., Atlanta, GA 30342.