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The use of pressure-controlled infusion in the management of pediatric post-tonsillectomy pain.
Pediatric post-tonsillectomy pain results in troublesome and potentially costly medical consequences that can necessitate hospitalization, medication overuse, or pain management. Case series report analysis of all pediatric surgical patients (ages 2-12 years) who received an intravenous patient-controlled analgesia (PCA) following tonsillectomy at a tertiary care children’s hospital from September 1, 2013, to July 31, 2014. The PCA was loaded with 1 mg/kg of hydromorphone (range, 0.5-1.4 mg/kg) using the original dose rate (2 mL/h; range, 0.5-2 mL/h), and boluses were initially set to 10 (range, 5-20) minutes and then escalated in 10-minute increments until postoperative pain was resolved (ie, patient-controlled oral analgesia [PCO]). Fifty-seven patients were included in the series, with 19 patients receiving PCO. PCA infusion rates ranged from 0.8 to 2.5 mL/h (mean, 1.6 mL/h). Fifteen of 57 patients (26%) were discharged with PCA versus 22 of 57 patients (39%) discharged with PCO. Because patients who received a PCA infusion had higher postoperative pain ratings, longer surgical times, were more likely to have overnight admission, and spent more time in the hospital (median, 3 days vs 3.5 days; P <.0001), and the PCA infusion resulted in lower overall cost ($2280 ± $977 vs $2793 ± $2207; P <.0001). The mean (±SD) total postoperative days until post-PCA discharge was 2.8 ± 1.2 days and 3.9 ± 2.3 days for patients receiving PCO and PCA, respectively (P =.0001). In this series, patients who received a PCA experienced significantly less intense and shorter-lasting pain compared with patients receiving PCO alone. It resulted in lower hospital costs. Therefore, if PCA can be used to standardize postoperative pain management, care should be directed toward maintaining high