Postoperative Pain Management in Children With Developmental Delay

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Parent- and nurse-controlled analgesia may not reduce postoperative pain in children with developmental delay.
Parent- and nurse-controlled analgesia may not reduce postoperative pain in children with developmental delay.

According to the results of a study recently published in Pain Medicine, parent- and nurse-controlled analgesia (PNCA) may not reduce postoperative pain in children with developmental delay compared with opioids administered by a nurse as needed.

In this randomized controlled trial, 81 children with developmental delay and in need of postoperative intravenous opioids for 24 hours or more were enrolled. Participants were randomly assigned to receive PNCA with basal infusion (0.02mg/kg/dose morphine equivalents and basal rate, 8-minute lockout period, with 0.12mg/kg as hourly maximum); PNCA without basal infusion (0.02mg/kg button dose with an 8-minute lockout and 0.12 mg/kg hourly maximum); or as-needed intravenous opioid administered by a nurse (0.08 mg/kg/dose available every 2 hours as-needed).

Pain scores, opioid consumption, and side effects were evaluated beginning at 12 hours post-anesthesia.

No significant difference in the rate of patients with pain scores <3 were reported in any of the treatment groups at any time point (P =.09 to P =.27). Opioid consumption was significantly higher in the PNCA with basal infusion group (median 0.03 mg/kg/h morphine equivalents) compared with the PNCA without basal infusion group (0.01 mg/kg/h) and the as-needed group (0.01 mg/kg/h). No difference in opioid consumption was reported between the PNCA without basal infusion group and the as-needed group.

The PNCA groups had more documented oxygen requirements compared with the as-needed group (P =.05). The rates of other side effects were similar in all groups.

The study investigators concluded that the study results "do not support a 'best practice recommendation' for PNCA." They noted, however, that "future studies with larger sample sizes are needed to better ascertain any potential advantage of PNCA with or without the use of a basal rate over [as-needed] opioids."

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Reference

Czarnecki ML, Hainsworth KR, Simpson PM, Weisman SJ. Parent/nurse-controlled analgesia compared with intravenous PRN opioids for postsurgical pain management in children with developmental delay: a randomized controlled trial [published online November 1, 2017]. Pain Med. doi:10.1093/pm/pnx257

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