Parent-Controlled Analgesia in Children Undergoing Cleft Palate Repair

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Journal of Korean Medical Science (Impact Factor: 1.27). 03/2008; 23(1):122-5. DOI: 10.3346/jkms.2008.23.1.122
Source: PubMed


The aims of this study were to find an optimal basal infusion dose of fentanyl for parent-controlled analgesia (PrCA) in children undergoing cleft palate repair and the degree of parents' satisfaction with PrCA. Thirty consecutive children between 6 months and 2 yr of age were enrolled. At the end of surgery, a PrCA device with a basal infusion rate of 2 mL/hr and bolus of 0.5 mL with lockout time of 15 min was applied. Parents were educated in patient-controlled analgesia (PCA) devices, the Wong Baker face pain scoring system, and monitoring of adverse effects of fentanyl. Fentanyl was infused 0.3 microgram/kg/hr at first, and we obtained a predetermined fentanyl regimen by the response of the previous patient to a larger or smaller dose of fentanyl (0.1 microgram/kg/hr as the step size), using an up-and-down method. ED50 and ED95 by probit analysis were 0.63 microgram/kg/hr (95% confidence limits, 0.55-0.73 microgram/kg/hr) and 0.83 microgram/kg/hr (95% confidence limits, 0.73-1.47 microgram/kg/hr), respectively. Eighty seven percent of the parents were satisfied with participating in the PrCA modality. PrCA using fentanyl with a basal infusion rate of 0.63 microgram/kg/hr can be applied effectively for postoperative pain management in children undergoing cleft palate repair with a high level of parents' satisfaction.

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    • "When vomiting occurred more than twice in 30 minutes or patients were intolerant to vomiting, metoclopramide 0.15 mg/kg was administered as a rescue antiemetic. In addition, numeric scaled pain scores (0-5, Wong-Baker's facial expression scale [4,19]) were evaluated. Ketorolac 1 mg/kg was intravenously administered as a rescue analgesic on the basis of the requirements of the children's care giver or pain score of more than 3. "
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