Use of patient-controlled analgesia for pain control in dying children.
BACKGROUND
In the last week of life, the daily opioid dose in children is highly variable, making the use of patient-controlled analgesia (PCA) a useful therapy option. Scientific data on the use of PCA in paediatric palliative care are rare.


METHODS
Retrospective chart review over a 7-year period (Jan 1998-Jan 2005) of PCA treated children dying of cancer was used.


RESULTS
Eight children were on PCA for a median duration of 9 days (range, 1 to 50). The daily median intravenous morphine equivalent dose referenced to body weight increased significantly when PCA was initiated and during the last week of life. In the last week of life, the median daily number of delivered and undelivered bolus requests ranged from 7.5-21 and 0-4.5, respectively. To meet children's individual needs, 39 PCA parametre changes on 22 opportunities were performed. Median daily mean pain scores remained low (range, 0-3; numerical rating scale 0-10) throughout the period.


CONCLUSIONS
PCA proved an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose to effect.
Schiessl
Christine
C
Department of Palliative Medicine, University Hospital Cologne, Kerpener Strasse 62, 50924, Cologne, Germany. Cnschiessl@aol.com
Gravou
Chara
C
Zernikow
Boris
B
Sittl
Reinhard
R
Griessinger
Norbert
N
D000293:Adolescent; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D009369:Neoplasms / Q000503:physiopathology*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy*; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine