Drivers of Patient Controlled Analgesia (PCA) Use in Children

Aim To evaluate the implications of cuing PCA medication availability and better understand children's decision-making process surrounding PCA use. Background Although Patient Controlled Analgesia (PCA) has been used in pediatrics >50 years, studies have not examined the effects of cuing PCA medication availability or factors that drive PCA use under these conditions. Specifically, PCAs can now cue the availability of opioid to the patient via the PCA button, which mandates an update to our use and understanding of PCAs. Method Study 1 included 125 children and adolescents who needed a PCA post-surgery. They were randomized to a “light” group (medication availability cued by PCA light) or control group (no cues to medication availability).Study 2 included 40 post-surgical children and adolescents who all used a PCA programmed to cue medication availability by PCA light. Patients and their parents were interviewed about factors surrounding PCA use within 36 hours after PCA discontinuation. Results For study 1, analyses found that patients in the light group consumed significantly more opioid than those in the control group (P=0.016).Study 2 showed that 92.5% of patients used the PCA for pain beyond their manageable threshold and 40% dosed due to anticipation of pain. Twenty-percent identified an outside factor played a role in their decision to press the button (i.e., getting catheter out, inducing sleep, or prompts from parent(s)/medical providers). The majority of patients (78%) reported their decisions were unaffected by the light cue. Parent reports were similar. Conclusions The first study suggests that children and adolescents used their PCA in response to the light more than in response to their pain. However, the second study suggests that patients primarily use PCA for pain, whether anticipatory or reactionary. Overall, these data update our understanding of PCA use in pediatrics, and support the need for more research in this area.