Patient-controlled analgesia
Humans; Pain; Adult; Analgesics; Patient Selection; Analgesia; Infusions; Injections; Intravenous; Dose-Response Relationship; Drug; Opioid/adverse effects/therapeutic use; Safety; Patient-Controlled/instrumentation; Postoperative/prevention & control; Respiration/drug effects
In appropriately selected patients, PCA safely provides analgesia superior to that obtained with traditional IM prn opioid administration; however, to date, no compelling evidence shows that PCA is associated with a reduction in morbidity or a more rapid recovery. PCA is deceptively easy to prescribe; however, to use it effectively and safely requires experience, frequent patient assessment, and a skilled and knowledgeable nursing staff.
1999
Etches RC
The Surgical Clinics Of North America
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0039-6109(05)70384-4" target="_blank" rel="noreferrer">10.1016/s0039-6109(05)70384-4</a>
Efficacy and complications of morphine infusions in postoperative paediatric patients
Child; Female; Humans; Male; Pain; Analgesics; Follow-Up Studies; Confidence Intervals; Incidence; Acute Disease; adolescent; Preschool; infant; retrospective studies; Infusions; Intravenous; Opioid/administration & dosage/adverse effects/therapeutic use; Morphine/administration & dosage/adverse effects/therapeutic use; Postoperative/prevention & control; Respiration/drug effects; Akathisia; Analgesia/nursing; Anesthesia Recovery Period; Anoxemia/chemically induced; Arousal/drug effects; Drug-Induced/etiology; Postoperative Nausea and Vomiting/chemically induced; Pruritus/chemically induced; Urinary Retention/chemically induced
The aim of the study was to evaluate the efficacy and the incidence of clinically significant adverse drug reactions (ADRs) in paediatric patients receiving continuous intravenous morphine infusions for acute postoperative pain. Definitions were established for ADRs and data were collected in an immediately retrospective fashion for a maximum of 72 h in 110 patients >/=5 three months of age (0.3-16.7 years) receiving morphine infusions and admitted to a general ward over a three month convenience sampling period. Inadequate analgesia occurred in 65.5% of patients during the first 24 h of therapy and occurred most frequently in patients with infusion rates of 20 microg.kg-1.h-1 or less. Nausea/vomiting was the most commonly experienced ADR (42.5%). The incidence of respiratory depression was 0% (95% CI=0-3.3%). Other ADRs included: urinary retention (13.5%), pruritus (12.7%), dysphoria (7.3%), hypoxaemia (4.5%), discontinuation of morphine for treatment of an ADR (3.6%), and difficulty in arousal (0.9%). The most common ADRs associated with morphine infusions were inadequate analgesia (in the first 24 h) and nausea/vomiting. There were no cases of respiratory depression. Methods of avoiding initial inadequate analgesia and treating nausea and vomiting associated with morphine infusions are needed.
1999
Esmail Z; Montgomery C; Courtrn C; Hamilton D; Kestle J
Paediatric Anaesthesia
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1046/j.1460-9592.1999.00384.x" target="_blank" rel="noreferrer">10.1046/j.1460-9592.1999.00384.x</a>
Ventilatory effects of morphine, pethidine and methadone in children
Child; Female; Humans; Male; Pain; Time Factors; Depression; Preschool; Non-U.S. Gov't; Research Support; Oxygen/blood; Postoperative/prevention & control; Respiration/drug effects; Chemical; Meperidine/pharmacology; Methadone/pharmacology; Morphine/pharmacology; Tidal Volume/drug effects
The ventilatory effects of single i.v. doses of morphine 0.1 mg kg-1, pethidine 0.67 mg kg-1 and methadone 0.1 mg kg-1 were compared after ophthalmic surgery in an open, randomized study in 30 children aged 3-8 yr. Ventilatory changes after each drug had distinctive profiles, with appreciable individual variation. Acutely, the decrease in ventilatory frequency was greater with pethidine and methadone than with morphine. The acute decrease in oxygen saturation was greater with methadone and pethidine than with morphine. Methadone produced a greater and longer lasting increase in end-tidal carbon dioxide and greater decrease in end-tidal oxygen than morphine or pethidine. Changes in end-tidal carbon dioxide and oxygen concentrations and saturation were most transient after pethidine and of longest duration after methadone. No child developed apnoea or hypoventilation requiring assistance.
1993
Hamunen K
British Journal Of Anaesthesia
1993
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/bja/70.4.414" target="_blank" rel="noreferrer">10.1093/bja/70.4.414</a>
Comparison of different bolus doses of morphine for patient-controlled analgesia in children
Child; Female; Male; Pain; Pain Measurement; Time Factors; Non-U.S. Gov't; Comparative Study; Nausea/chemically induced; Human; Support; Adolescence; Patient-Controlled; Sleep/drug effects; Vomiting/chemically induced; Appendectomy; Analgesia; Morphine/administration & dosage/adverse effects; Postoperative/prevention & control
Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. Group B20 self-administered considerably more morphine (P < 0.01) than group B10. There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.
1994
Doyle E; Mottart KJ; Marshall C; Morton NS
British Journal Of Anaesthesia
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/bja/72.2.160" target="_blank" rel="noreferrer">10.1093/bja/72.2.160</a>
Comparison of morphine and methadone for prevention of postoperative pain in 3- to 7-year-old children
Child; Female; Male; Pain; Pain Measurement; Prospective Studies; Analysis of Variance; Double-Blind Method; Preschool; Non-U.S. Gov't; Comparative Study; Drug Evaluation; Human; Support; Postoperative/prevention & control; algorithms; Intraoperative Care; Methadone/adverse effects/pharmacokinetics/therapeutic use; Morphine/adverse effects/therapeutic use
A randomized, double-blind, prospective study was performed to determine the effects of perioperative administration of morphine or methadone on postoperative analgesic requirements and pain scores in 35 children aged 3 to 7 years undergoing major surgery. After a standardized induction of anesthesia, methadone or morphine, 0.2 mg/kg, was blindly administered, and supplemental doses were titrated to achieve comfort in the recovery room. Pain was assessed during the next 36 hours with a combination of validated behavioral and self-report measures. Patients in the methadone group required fewer supplemental opioid analgesic drugs during the next 36 hours, and reported lower pain scores. No patient had prolonged emergence from anesthesia, and no patient required naloxone or postoperative ventilatory assistance. No major adverse events occurred. We conclude that perioperative intravenous administration of methadone is an effective, inexpensive, and technologically simple means for providing prolonged analgesia for children after surgery.
1991
Berde CB; Beyer JE; Bournaki MC; Levin CR; Sethna NF
Journal Of Pediatrics
1991
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Journal Article