Parent-controlled analgesia in children undergoing cleft palate repair

Abstract

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.

Fig. 1

The responses of 30 consecutive patients by the parent-controlled analgesic (PrCA) modality with different fentanyl regimens. Patient's response to the PrCA regimen was described as 'Effective' (open circle) or 'Not effective' (close circle). Fentanyl regimen was coded by the numeric of the basal infusion rate ( µg/kg/hr). Arrows indicate the midpoint of fentanyl regimens of all independent pairs of patients, involving a crossover from 'Not effective' to 'Effective'.

Fig. 2

Probit analysis of fentanyl regimen. Triangles in the bottom represent the patients of 'Not effective', and reverse triangles in the top represent the patients of 'Effective'. Regression plot and line were displayed according to probit analysis.