Postoperative Patient-Controlled Analgesia in the Pediatric Cardiac Intensive Care Unit.
BACKGROUND
High rates of uncontrolled pain in critically ill patients remain common. Patient-controlled analgesia is more effective than traditional intravenous as-needed dosing regimens for managing postoperative pain in older children and adults.


OBJECTIVE
To determine whether pain-related clinical outcomes in patients from age 10 years to adult following cardiac surgery are improved by using patient-controlled analgesia as a pain management strategy.


METHODS
Using the plan-do-study-act method of quality improvement, a process was instituted to have both staff and patients' families support the use of patient-controlled analgesia postoperatively as opposed to traditional pain control with as-needed analgesics. Use of as-needed medications and pain scores were retrospectively compared from before to after initiation of patient-controlled analgesia.


RESULTS
The cumulative mean pain score from the time of extubation through the following 24 hours decreased from 4.14 (on a scale from 0 to 10) when strictly as-needed medications were used to 2.8 with patient-controlled analgesia. Further, the mean amount of opioid consumed decreased from 14.98 mg of morphine and 22.27 mg of oxycodone to 13.58 mg of morphine and 3.33 mg of oxycodone after implementation of patient-controlled analgesia.


CONCLUSIONS
Standardized use of patient-controlled analgesia for postoperative pain management in patients 10 years of age through adulthood is efficient and effective, as evidenced by less medication being consumed by patients and lower mean pain scores.
Hanna Epstein is a graduate of the Doctor of Nursing Practice program at the Medical University of South Carolina in Charleston, South Carolina. She is credentialed as a pediatric nurse practitioner and is currently practicing inpatient pediatric palliative care. gardnerh@musc.edu.
Hanna M
HM
Epstein
D000293:Adolescent; D000698:Analgesia / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006784:Hospitals, Teaching; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D000701:Analgesics, Opioid