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

Abstract

To describe Patient-Controlled Analgesia (PCA) administration in pediatric patients admitted with sickle cell vaso-occlusive episode (VOE). 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. 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. 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.