Pain control in the pediatric patient--the role of anaesthesia

Intravenous patient-controlled analgesia using remifentanil in a child with Axenfeld-Rieger syndrome

Patient-controlled analgesia (PCA) using intravenous opioids is increasing in popularity for children aged 5 years and over. To our knowledge there are no reports on the use of PCA in children with remifentanil in the postoperative period. We report successful use of remifentanil for intravenous (IV) PCA in a child scheduled for suprasellar arachnoid cystectomy with Axenfeld-Rieger syndrome who needed good postoperative analgesia because of accompanying serious problems.

Patient-controlled analgesia for the pediatric patient

Pediatric patients benefit from patient-controlled analgesia (PCA), which eliminates the need for painful intramuscular injections of opioids and improves the child's sense of control. Age is often used inappropriately as a criterion for PCA use in children. Children must be carefully screened for their cognitive and physical ability to manage their pain using PCA. Family-controlled analgesia and nurse-controlled analgesia may be considered in select cases as alternatives to PCA in children with cognitive or physical disabilities. PCA dosage regimens must be individualized on the basis of age. Monitoring parameters must be age appropriate. Potential adverse effects of PCA therapy, including respiratory depression, nausea, vomiting, and pruritus, can be prevented or controlled. Clinicians must become aware of age-related and developmental differences in the pharmacokinetic, pharmacodynamic, and monitoring parameters for the pediatric patient. The safety and efficacy of PCA in pediatric patients has been established, and its role has increased beyond postoperative pain management.

[Analgesia controlled by the patient in pediatrics]

The development of patient controlled analgesia (PCA) in children is the result of a search for an analgesia being both maximally efficient and secure, in the management of severe pain. The technique is based on self infusions of an analgesic, mainly morphine, by the child, through a special pump. The quality of the pump is essential in order to exclude any risk of overdosage. In order to prevent potential secondary effects and complications, a careful supervision is mandatory (clinical, by pulse oximetry, regular checking of pump parameters). PCA is applicable to children older than 5 years. The main indications are post-operative and oncological pains.

Continuous epidural morphine/butorphanol infusion following selective dorsal rhizotomy in children

The authors prospectively evaluated 15 patients who had undergone selective dorsal rhizotomy who were given a continuous morphine/butorphanol infusion, to determine whether variations in the postoperative pain control and side effects seen using a bolus technique could be reduced. Patients had an epidural catheter placed at the end of the operative procedure through which 50-60 micrograms/kg preservative-free morphine and 15-20 micrograms/kg butorphanol was administered. A continuous epidural infusion of 5 micrograms/kg h morphine and 1.2 micrograms/kg h butorphanol was then initiated. Postoperatively, mean pain scores were excellent. No patient required additional systemic analgesics during the 72-h investigational period. A low incidence of nausea, and no vomiting, pruritus, or respiratory depression was reported by the cohort. All patients maintained oxygen saturations above 95%. This indicates that the use of a continuous epidural infusion provides excellent pain control, decreases the occurrence of untoward side effects, and allows the early initiation of occupational and physical therapy postoperatively.