The Safety of Patient-Controlled Analgesia by Proxy in Pediatric Oncology Patients

Between February 1999 and December 2003, we studied the use of patient-controlled analgesia (PCA) to control pain in 1011 children and young adults with cancer, by evaluating 4972 24-h periods of PCA usage, 576 of which involved PCA by proxy. Selection of patients for PCA by proxy was based on young...

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Bibliographic Details
Published inAnesthesia and analgesia Vol. 101; no. 6; pp. 1623 - 1627
Main Authors Anghelescu, Doralina L, Burgoyne, Laura L, Oakes, Linda L, Wallace, Debora A
Format Journal Article
LanguageEnglish
Published Hagerstown, MD International Anesthesia Research Society 01.12.2005
Lippincott
Subjects
Adolescent
Adult
Analgesia, Patient-Controlled - adverse effects
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Child
Child, Preschool
Humans
Infant
Infant, Newborn
Medical sciences
Neoplasms - physiopathology
Proxy
Respiration - drug effects
Human
Analgesia
Pediatrics
Anesthesia
Child
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Summary:Between February 1999 and December 2003, we studied the use of patient-controlled analgesia (PCA) to control pain in 1011 children and young adults with cancer, by evaluating 4972 24-h periods of PCA usage, 576 of which involved PCA by proxy. Selection of patients for PCA by proxy was based on younger age group, neuromuscular limitation, expectation of repeated painful procedures, and terminal disease. We measured the incidence of respiratory and neurological complications related to the use of PCA. Major complications were observed during 70 of the 4972 24-h observations, with 28 of 4972, or 0.56%, involving respiratory complications, 35 of 4972, or 0.7%, involving neurological complications, and 7 of 4972 24-h observations, or 0.14%, involving both respiratory and neurological complications. In the PCA by proxy group, two respiratory complications and two neurological complications were observed. Reversal of opioid-related respiratory or neurological effects with naloxone was required in three instances, two in the standard PCA group and one in the PCA by proxy group. Recommendations to ensure continuing safety include careful patient selection, education of proxy users, appropriate documentation, and institutional guidelines.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0003-2999
1526-7598
DOI:10.1213/01.ANE.0000184198.13285.33