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.

Postoperative pain management after spinal fusion surgery: an analysis of the efficacy of continuous infusion of local anesthetics.

Spinal fusion surgery is a major surgery that results in severe postoperative pain, therefore pain reduction is a primary concern. New strategies for pain management are currently under investigation and include multimodal treatment. A 3-year retrospective analysis of patients with idiopathic scoliosis undergoing spinal fusion surgery was performed at our hospital, assessing patient pain scores, opioid use, and recovery. We evaluated the effect of adding continuous infusion of local anesthetics (CILA) to a postoperative pain management protocol that includes intraoperative intrathecal morphine, as well as postoperative patient-controlled analgesia and oral opioid/acetaminophen combination. The study compared 25 patients treated according to the standard protocol, with 62 patients treated with CILA in addition to the pain management protocol. Patients in the CILA group used nearly 0.5 mg/kg less opioid analgesics during the first 24 hours after surgery.