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Parent‐assisted or nurse‐assisted epidural analgesia: is this feasible in pediatric patients?
Author(s) -
BIRMINGHAM PATRICK K.,
SURESH SANTHANAM,
AMBROSY ANDREW,
PORFYRIS SUZANNE
Publication year - 2009
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2009.03151.x
Subject(s) - medicine , sedation , modalities , pain control , anesthesia , patient controlled analgesia , depression (economics) , institutional review board , cohort , postoperative pain , surgery , social science , sociology , economics , macroeconomics
Summary Aim: The aim of this study was to assess the feasibility of parent‐assisted or nurse‐assisted epidural analgesia (PNEA) for control of postoperative pain in a pediatric surgical population. Methods: After the institutional review board (IRB) approval was obtained, an analysis of our pain treatment services database of pediatric surgical patients with epidural catheters in whom the parent and/or nurse were empowered to activate the epidural demand‐dose button was evaluated. Results: Over a 10 ‐year period between 1999 and 2008, 128 procedures in 126 patients were provided parent or nurse assistance of the epidural demand dose. Satisfactory analgesia was obtained in 86% of patients with no or minor adjustments in PNEA parameters. Fourteen percent of patients were converted to intravenous patient‐controlled analgesia (PCA) for inadequate analgesia (7%) or side effects (7%). None of the patients in this cohort required treatment for respiratory depression or excessive sedation. Conclusions: Parent‐assisted or nurse‐assisted epidural analgesia can be safely administered to children undergoing surgery who are physically or cognitively unable or unwilling to self‐activate a demand dose. Additional studies are needed to compare the efficacy of PNEA with other modalities for postoperative pain control in children.