A preliminary report of parent/nurse-controlled analgesia (PNCA) in infants and preschoolers.
BACKGROUND
infants and young children are often unable to verbalize pain or advocate for themselves which may increase their risk for poor pain assessment and management. Although patient-controlled analgesia (PCA) has been shown to be safe, effective, and superior to intermittent opioid dosing, infants and young children are not able to operate PCA independently. Allowing a parent or nurse to operate the PCA for the child [parent/nurse-controlled analgesia (PNCA)] may be an option for these children. However, the use of PNCA has been heavily scrutinized and more evidence of safety is needed to support this practice.


OBJECTIVE
the primary purpose of this study was to evaluate safety outcomes associated with PNCA for infants and preschool aged children. Secondary outcomes regarding the frequency of untoward side effects and clinical effectiveness were also examined.


METHODS
a retrospective review of treatment with PNCA was conducted from a convenience sample of charts for 107 infants and preschoolers. Data were collected for 72 hours or until the PNCA was discontinued.


RESULTS
one hundred and seven infants and preschoolers with a mean age of 19.6 months (±12.12) were represented in this study. Mean pain scores were low, as was the number of PNCA injections and attempts and amount of opioid administered. Common opioid side effects were reported. Naloxone was administered to 1.9% of patients for respiratory depression, and potential contributing factors were identified.


CONCLUSIONS
diligent monitoring and education are crucial to ensure safety. Untoward side effects adverse events and pain scores suggest PNCA may be an effective method of pain control for this patient population.
Czarnecki
Michelle L
ML
Jane B. Pettit Pain and Palliative Care Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53201, USA. mczarnecki@chw.org
Salamon
Katherine S
KS
Jastrowski Mano
Kristen E
KE
Ferrise
Antonella S
AS
Sharp
Mickel
M
Weisman
Steven J
SJ
D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010146:Pain / Q000453:epidemiology* / Q000451:nursing / Q000517:prevention & control*; D010290:Parents; D010865:Pilot Projects; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D014922:Wisconsin / Q000453:epidemiology
D000701:Analgesics, Opioid