PMID- 30655310
OWN - NLM
STAT- MEDLINE
DCOM- 20200323
LR  - 20200323
IS  - 2154-1663 (Print)
IS  - 2154-1671 (Linking)
VI  - 9
IP  - 2
DP  - 2019 Feb
TI  - Patient- and Nurse-Controlled Analgesia: 22-Year Experience in a Pediatric 
      Hospital.
PG  - 129-133
LID - 10.1542/hpeds.2018-0179 [doi]
AB  - OBJECTIVES: Pediatric pain management has rapidly changed over the last 2 
      decades. In this study, we describe the changing practices and adverse events 
      (AEs) related to patient-controlled analgesia (PCA) and/or nurse-controlled 
      analgesia (NCA) over a 22-year period. METHODS: After institutional review board 
      approval, retrospective data from a single tertiary-care pediatric hospital were 
      collected between 1994 and 2016. Subgroup analyses were done for surgical and 
      medical case patients. We reported the number of times that PCA and/or NCA was 
      ordered annually, the median and interquartile ranges for age, PCA and/or NCA 
      duration and length of stay, and AE frequencies. RESULTS: Over 22 years, 32 338 
      PCAs and/or NCAs were ordered in this institution. Morphine and hydromorphone 
      were used most commonly. Between 1994 and 2006, initial orders for PCA and/or NCA 
      increased 2.5-fold. After 2007, initial orders for PCA and/or NCA rapidly 
      decreased; after 2013, the decrease continued at a slower rate, with a total of 
      1007 orders in 2016. This decrease occurred despite increased hospital admissions 
      and surgeries. Between 2007 and 2012, peripheral nerve blocks rapidly increased 
      (10-fold). After 2002, 146 AEs were reported (1.0%). Of those, 50.5% were 
      nonintercepted, and 20.6% were intercepted AEs; 5.5% and 6.2% were preventable 
      and nonpreventable AEs, respectively. CONCLUSIONS: PCA and/or NCA usage continues 
      to be common in pediatric patients, although usage has declined and stabilized in 
      the setting of other emerging methods of analgesia and increases in the number of 
      minimally invasive surgical procedures. The overall rate of AEs was extremely 
      low. However, improvements to eliminate all errors are needed, especially with 
      medications with a great risk of harm (such as opioids).
CI  - Copyright (c) 2019 by the American Academy of Pediatrics.
FAU - Donado, Carolina
AU  - Donado C
AD  - Departments of Anesthesiology, Critical Care, Pain Medicine.
AD  - Departments of Anesthesia and.
FAU - Solodiuk, Jean
AU  - Solodiuk J
AD  - Departments of Anesthesiology, Critical Care, Pain Medicine.
AD  - Departments of Anesthesia and.
FAU - Rangel, Shawn J
AU  - Rangel SJ
AD  - Surgery.
AD  - Pediatric Surgery.
FAU - Nelson, Caleb P
AU  - Nelson CP
AD  - Urology, General Pediatrics.
AD  - Medicine.
FAU - Heeney, Matthew M
AU  - Heeney MM
AD  - Cancer and Blood Disorders Center and.
AD  - Cancer and Blood Disorders Center, and.
AD  - Department of Cancer and Blood Disorders Center, and.
FAU - Mahan, Susan T
AU  - Mahan ST
AD  - Orthopedic Surgery.
AD  - Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts; and.
FAU - Ullrich, Christina
AU  - Ullrich C
AD  - Department of Cancer and Blood Disorders Center, and.
AD  - Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, 
      Massachusetts.
FAU - Tsegaye, Binyam
AU  - Tsegaye B
AD  - Anesthesiology Information Technology, Boston Children's Hospital, Boston, 
      Massachusetts.
FAU - Berde, Charles B
AU  - Berde CB
AD  - Departments of Anesthesiology, Critical Care, Pain Medicine, 
      charles.berde@childrens.harvard.edu.
AD  - Departments of Anesthesia and.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190117
PL  - United States
TA  - Hosp Pediatr
JT  - Hospital pediatrics
JID - 101585349
RN  - 0 (Analgesics, Opioid)
RN  - 76I7G6D29C (Morphine)
RN  - Q812464R06 (Hydromorphone)
SB  - IM
MH  - Adolescent
MH  - Analgesia, Patient-Controlled/*trends
MH  - Analgesics, Opioid/*administration & dosage
MH  - Boston
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Hospitals, Pediatric/*trends
MH  - Humans
MH  - Hydromorphone/*administration & dosage
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Morphine/*administration & dosage
MH  - Pain Management/methods/trends
MH  - Practice Patterns, Nurses'/*trends
MH  - Retrospective Studies
COIS- POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential 
      conflicts of interest to disclose.
EDAT- 2019/01/19 06:00
MHDA- 2020/03/24 06:00
CRDT- 2019/01/19 06:00
PHST- 2019/01/19 06:00 [pubmed]
PHST- 2020/03/24 06:00 [medline]
PHST- 2019/01/19 06:00 [entrez]
AID - hpeds.2018-0179 [pii]
AID - 10.1542/hpeds.2018-0179 [doi]
PST - ppublish
SO  - Hosp Pediatr. 2019 Feb;9(2):129-133. doi: 10.1542/hpeds.2018-0179. Epub 2019 Jan 
      17.