Patient-controlled analgesia in children and adolescents: A randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia
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Abstract
A randomized, prospective trial of patient-controlled analgesia (PCA), that is, a
method of analgesia administration involving a computer-driven pump activated by patients
to receive small doses within defined limits was performed in 82 children and adolescents
after major orthopedic surgery to compare (1) intramuscularly administered morphine,
(2) PCA morphine and (3) PCA morphine with a low-dose continuous morphine infusion
(PCA-plus). Patients receiving PCA and PCA-plus had lower pain scores and greater
satisfaction than patients receiving intramuscularly administered morphine. The three
groups used equal amounts of morphine and most measures of recovery were identical
in the groups. In particular, PCA and PCA-plus did not increase the incidence of opioid-related
complications, and patients receiving PCA-plus were less sedated than patients receiving
intramuscular therapy. We conclude that PCA and PCA-plus are safe and effective methods
of pain relief in children and adolescents after orthopedic surgery, are better accepted
than intramuscular injections, and do not increase perioperative morbidity.