Use of patient-controlled analgesia for pain control in dying children

Use of patient-controlled analgesia for pain control in dying children

Schiessl C; Gravou C; Zernikow B; Sittl R; Griessinger N

Supportive Care In Cancer

2008

Analgesia Patient-Controlled; Analgesics Opioid/tu [Therapeutic Use]; Morphine/tu [Therapeutic Use]; Neoplasms/pp [Physiopathology]; Pain Intractable/dt [Drug Therapy]; 0 (Analgesics Opioid); 76I7G6D29C (Morphine); adolescent; Analgesics Opioid/ad [Administration & Dosage]; Child; Child Preschool; Female; Humans; Male; Morphine/ad [Administration & Dosage]; Pain Measurement; Palliative Care; retrospective studies; Terminal Care; Treatment Outcome

BACKGROUND: In the last week of life, the daily opioid dose in children is highly variable, making the use of patient-controlled analgesia (PCA) a useful therapy option. Scientific data on the use of PCA in paediatric palliative care are rare. MATERIALS AND METHODS: Retrospective chart review over a 7-year period (Jan 1998-Jan 2005) of PCA treated children dying of cancer was used. RESULTS: Eight children were on PCA for a median duration of 9 days (range, 1 to 50). The daily median intravenous morphine equivalent dose referenced to body weight increased significantly when PCA was initiated and during the last week of life. In the last week of life, the median daily number of delivered and undelivered bolus requests ranged from 7.5-21 and 0-4.5, respectively. To meet children's individual needs, 39 PCA parametre changes on 22 opportunities were performed. Median daily mean pain scores remained low (range, 0-3; numerical rating scale 0-10) throughout the period. CONCLUSION: PCA proved an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose to effect.

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