title: Parent-assisted or nurse-assisted epidural analgesia: is this feasible in pediatric patients?
abstract: OBJECTIVE
  The aim of this study was to assess the feasibility of parent-assisted or nurse-assisted epidural analgesia (PNEA) for control of postoperative pain in a pediatric surgical population.
  
  
  METHODS
  After the institutional review board (IRB) approval was obtained, an analysis of our pain treatment services database of pediatric surgical patients with epidural catheters in whom the parent and/or nurse were empowered to activate the epidural demand-dose button was evaluated.
  
  
  RESULTS
  Over a 10 -year period between 1999 and 2008, 128 procedures in 126 patients were provided parent or nurse assistance of the epidural demand dose. Satisfactory analgesia was obtained in 86% of patients with no or minor adjustments in PNEA parameters. Fourteen percent of patients were converted to intravenous patient-controlled analgesia (PCA) for inadequate analgesia (7%) or side effects (7%). None of the patients in this cohort required treatment for respiratory depression or excessive sedation.
  
  
  CONCLUSIONS
  Parent-assisted or nurse-assisted epidural analgesia can be safely administered to children undergoing surgery who are physically or cognitively unable or unwilling to self-activate a demand dose. Additional studies are needed to compare the efficacy of PNEA with other modalities for postoperative pain control in children.
authors.affiliation: Pain Management Services, Department of Anesthesiology, Northwestern University's Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL 60614, USA. pbirmingham@northwestern.edu
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Birmingham
authors.forename: Santhanam
authors.initials: S
authors.lastname: Suresh
authors.forename: Andrew
authors.initials: A
authors.lastname: Ambrosy
authors.forename: Suzanne
authors.initials: S
authors.lastname: Porfyris
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods* / Q000451:nursing; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008137:Longitudinal Studies; D010147:Pain Measurement; D010149:Postoperative Pain / Q000451:nursing / Q000517:prevention & control*; D010290:Parents; D016896:Treatment Outcome