Abstract
Objective
To describe Patient-Controlled Analgesia (PCA) administration in pediatric patients
admitted with sickle cell vaso-occlusive episode (VOE).
Methods
This single-center retrospective study included all inpatient hematology admissions
for VOE between 2014 and 2020. PCA-ratio was calculated as the ratio of bolus over
continuous IV opioids dose, and time to PCA adjustment as time between first PCA order
and a subsequent order that increased dosing or changed opioid medication.
Results
A total of 866 encounters (172 unique patients) with PCA for VOE were included. The
mean age was 15.4 years old (SD = 5.0). On average, after admission (hospital arrival),
the first opioid dose was given at 1 hour, PCA started at 3.5 hours, and mean length
of stay was 4.3 days (SD = 2.5). The mean initial PCA-ratio was 1.7 (SD = 0.6). There
were no significant associations between age, gender, initial pain score, or admission
hemoglobin and PCA-ratio (linear regression model P = 0.443). In 24.7% of encounters, the PCA was adjusted within 6 hours. After adjusting by age and gender, lower admission pain scores (OR = 1.15, P = 0.004), lower PCA-ratio (OR = 2.1, P = 0.003), longer time to PCA start (OR = 1.2, P = 0.001), and no adjuvant ketamine (OR = 2.4, P < 0.001) were associated with PCA unadjusted within 6 hours.
Conclusion
At our institution, patients with VOE received opioids and PCA within the first hours
of admission. PCAs were started at a ratio of 1.5–1.8, considered normal continuous.
While no specific PCA-ratio was clearly superior for pain control, lower ratios (high
continuous infusion) were associated with not requiring PCA adjustments at 6 hours.
Prospective studies are needed.
Key Words
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Article info
Publication history
Published online: January 11, 2023
Accepted:
December 24,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
