A PRISMA Systematic Review on the Safety and Efficacy of Patient-Controlled Analgesia (PCA) in Pediatrics

Abstract

ProblemEffective pain management is the key to improving not only patient outcomes but also patient satisfaction. Patient controlled analgesia (PCA) is a pain management method that allows the patient to self-administer their medication. Because of the great variety of physical and cognitive abilities in the pediatric population, involvement of a nurse or parent proxy is necessary. PurposeThe purpose of this study was to ascertain the most effective approaches to PCA in pediatric settings. Eligibility criteriaCriteria for articles selection were as follows: (a) published in a peer-review journal, (b) between 2014 and 2019, (c) in English, (d) directly addressing the issues of safety and efficacy of patient-controlled analgesia by proxy in the pediatric patient population. SampleDatabases used in the search included CINAHL Plus with Full Text, DynaMed, MedLine with Full Text, and ScienceDirect. Combinations of the following keywords were used to search each database: “nurse controlled analgesia”, “parent controlled analgesia”, “patient controlled analgesia by proxy”, “NCA”, “P/NCA”, “PCA by proxy”, “pediatrics”, “children”, “pediatric patients”. Database searches yielded 172 results. Articles that were duplicated, missing inclusion criteria or did not directly address the issues of safety and efficacy of PCA by proxy were removed. Eleven articles fit the selection criteria. ResultsEleven articles were included in the final report. The themes that emerged from the analysis included pain management of neonates and infants, children with developmental disabilities, children with cancer, as well as the sources and possible solutions to errors in medication preparation. ConclusionsIt was concluded that PCA by proxy remains a safe and efficient method of pain administration for the pediatric population, with the exception of children suffering from developmental and neurological disabilities. ImplicationsPCA by proxy, although presenting challenges, remains a safe and efficient way of pain management across different pediatric populations, such as infants and neonates or children with cancer, both inpatient and outpatient, and new technologies could positively influence the safety of this method of pain management. Conversely, children with developmental and neurological disabilities do not benefit from this method of pain management and are more prone to experiencing adverse effects.