title: An audit of patient-controlled analgesia after appendicectomy in children.
abstract: BACKGROUND
  Patient-controlled analgesia (PCA) is commonly used after appendicectomy in children.
  
  
  OBJECTIVE
  The aim of this study was to characterize the analgesic use of children prescribed PCA after appendicetomy, in order to rationalize future use of this modality.
  
  
  METHODS
  We retrospectively audited all cases of acute appendicitis over a 4-year period in a single pediatric hospital, recording demographics, surgical approach, pathology, analgesia use, pain scores, and duration of PCA. We preplanned subgroup analyses for surgical approach, pathology, and intraoperative nonsteroidal anti-inflammatory drug (NSAID) administration. We subsequently identified a patient subgroup who were unlikely to require PCA and conducted a (2 months) prospective audit of such patients (uncomplicated appendicitis with intraoperative NSAID) having non-PCA (oral) analgesia.
  
  
  RESULTS
  Of the 649 patients undergoing appendicectomy for acute appendicitis, 85% were prescribed an opioid PCA, 8% received an opioid infusion (younger patients), and 7% received neither PCA nor infusion. Of the 541 bolus only PCA patients, 49% had laparoscopic surgery, 36% had complicated appendicitis, and 49% received intraoperative NSAID (diclofenac). Mean (SD) duration of PCA was shorter with uncomplicated vs complicated appendicitis (21.9 ± 10.7 vs 32.8 ± 21.1 h, P < 0.001, difference in means [95% CI]: 10.9 [7.7-14.1]), and with intraoperative NSAID (23.2 ± 14.4 vs 28.4 ± 17.4 h, P < 0.001, difference in means [95% CI]: 5.2 [2.5-7.9]). There was no difference in the time to PCA cessation between laparoscopic and open approach. Morphine consumption and pain scores were lower in the early postoperative period for those patients receiving intraoperative NSAID. In the prospective audit, 44 of 69 patients had uncomplicated appendicitis. Thirty-eight of these were prescribed oral analgesia and none required any parenteral opioid or acute pain service intervention postoperatively. Parental satisfaction level was high (>90%) with oral analgesia.
  
  
  CONCLUSIONS
  It is feasible that children with uncomplicated appendicitis given intraoperative NSAID can be successfully managed without PCA.
authors.affiliation: Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Ousley
authors.affiliation: Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Burgoyne
authors.affiliation: Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia.
authors.forename: Nicola R
authors.initials: NR
authors.lastname: Crowley
authors.affiliation: Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia.|Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.|Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
authors.forename: Warwick J
authors.initials: WJ
authors.lastname: Teague
authors.affiliation: Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia.|Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Costi
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001062:Appendectomy; D002648:Child; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac
keywords: acute pain; analgesia; appendectomy; appendicitis; child; laparoscopy; patient-controlled