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Parent/Nurse-controlled Analgesia for Children With Developmental Delay

Czarnecki, Michelle L. RN-C, MSN, CPNP*; Ferrise, Antonella S. BSN, RN; Jastrowski Mano, Kristen E. PhD; Garwood, Molly Murphy PhD; Sharp, Mickel MD; Davies, Hobart PhD* † §; Weisman, Steven J. MD* †

doi: 10.1097/AJP.0b013e3181773b69
Original Articles

Background: Children with developmental delay are often unable to verbalize pain or advocate for themselves owing to cognitive, motor, or verbal limitations, which puts them at increased risk for poor pain assessment and management. Although patient-controlled analgesia has been shown to be safe, effective, and superior to intermittent opioid dosing, not all children can operate patient-controlled analgesia independently. Parent/nurse-controlled analgesia (PNCA) may be an option for these children. However, the safety and efficacy of PNCA have not been thoroughly evaluated and many practitioners are reluctant to use it.

Objectives: The purpose of this study was to evaluate the outcomes associated with PNCA in pediatric patients with identified developmental delay.

Methods: A retrospective review of treatment with PNCA was conducted from a convenience sample of charts for 71 children with developmental delay. Data were collected for 72 hours or until the PNCA was discontinued, whichever came first.

Results: Mean pain scores were low, as was the amount of opioid required to keep patients comfortable. Side effects, with the exception of oxygen therapy, were similar to previous studies regarding PNCA. Somnolence and respiratory depression leading to the administration of naloxone occurred in 2.8% of patients, and potential causes were identified.

Discussion: Pain scores, side effects, and adverse events suggest that PNCA may be an effective method of pain control for children with developmental delay. Diligent monitoring and education are crucial to ensure safety.

*Jane B. Pettit Pain and Palliative Care Center, Children's Hospital of Wisconsin

Medical College of Wisconsin

§University of Wisconsin-Milwaukee, Milwaukee

Gundersen Lutheran Hospital, LaCrosse, WI

This study was funded by Children's Hospital of Wisconsin Foundation (now Children's Research Institute) and supported by the Jane B. Pettit Pain and Palliative Care Center.

Reprints: Michelle L. Czarnecki, RN-C, MSN, CPNP, Jane B. Pettit Pain and Palliative Care Center, Children's Hospital of Wisconsin, PO Box 1997, MS 792, Milwaukee, WI 53201 (e-mail: mczarnecki@chw.org).

Received for publication December 24, 2007; revised February 29, 2008; accepted March 25, 2008

© 2008 Lippincott Williams & Wilkins, Inc.