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Patient Controlled Analgesia for Vaso-Occlusive Episodes in Children: A Retrospective Study

  • Carolina Donado
    Affiliations
    Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA

    Department of Anaesthesia, Harvard Medical School (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA
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  • Emily M. Harris
    Affiliations
    Department of Pediatrics, Boston Children's Hospital (E.M.H., M.M.H., N.M.A.), Boston, Massachusetts, USA
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  • Matthew M. Heeney
    Affiliations
    Department of Pediatrics, Boston Children's Hospital (E.M.H., M.M.H., N.M.A.), Boston, Massachusetts, USA

    Division of Hematology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center (M.M.H., N.M.A.), Boston, Massachusetts, USA
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  • Jean C. Solodiuk
    Affiliations
    Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA

    Department of Anaesthesia, Harvard Medical School (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA
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  • Christine D. Greco
    Affiliations
    Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA

    Department of Anaesthesia, Harvard Medical School (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA
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  • Natasha M. Archer
    Correspondence
    Address correspondence to: Natasha M. Archer, MD, MPH, Division of Hematology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, 300 Longwood Ave., Boston, MA 02215, USA.
    Affiliations
    Department of Pediatrics, Boston Children's Hospital (E.M.H., M.M.H., N.M.A.), Boston, Massachusetts, USA

    Division of Hematology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center (M.M.H., N.M.A.), Boston, Massachusetts, USA
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      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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