title: Patient-controlled analgesia at the end of life at a pediatric oncology institution.
abstract: BACKGROUND
  Patient controlled anesthesia (PCA) is increasingly used to manage pain in pediatric cancer patients and is important in the treatment of escalating pain at the end of life. The description of the use of opioid PCA in this population has been limited.
  
  
  METHODS
  This retrospective chart review of the last 2 weeks of life addressed the following objectives: (1) to describe the patient population treated with opioid PCA; (2) to describe the morphine-equivalent doses (MED) (mg/kg/day); and (3) to describe the pain scores (PS).
  
  
  RESULTS
  Twenty-eight percent of inpatients used opioid PCA for pain control during the last 2 weeks of life. The mean MED (mg/kg/day) (SD) at 2 weeks prior and the day of death were 10.7 (17.9) and 19 (25.8). The mean MED increased over the last 2 weeks of life for all patients and across age groups and cancer diagnoses (all P < 0.05). The mean MED was significantly higher in the younger age group (age <13 vs. age ≥ 13) on the day of death (P < 0.04). There was a significant change in mean PS over the last 2 weeks of life (P < 0.001), with the highest PS on the day before death. The most frequently used concurrent medications were benzodiazepines (91%).
  
  
  CONCLUSIONS
  Children and young adults with cancer experience high opioid requirements and significant dose increases during the last 2 weeks of life. Additionally, PS increase toward the end of life. Opioid rotation and addition of adjuvant medications merit consideration in the context of escalating opioid requirements.
authors.affiliation: Division of Anesthesiology, Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Doralina L
authors.initials: DL
authors.lastname: Anghelescu
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Snaman
authors.affiliation: Division of Anesthesiology, Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Luis
authors.initials: L
authors.lastname: Trujillo
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: April D
authors.initials: AD
authors.lastname: Sykes
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Y
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Justin N
authors.initials: JN
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D019452:Terminally Ill; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Pediatric pain control; opioid analgesics; pain control
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