Schmerztherapie bei Kindern und Erwachsenen nach Trichterbrustkorrektur - Eine retrospektive Analyse der Analgetikamedikation nach Bedarf und mit PCA

Abstract: Postoperative pain therapy often appears to be inadequate in children. The present study was a retrospective investigation of the administration of analgesics given to 133 children and adults following surgery for funnel chest between 1983 and 1994. Methods: Pain therapy was performed with PRN (prore nata) administration in 100 patients (4-36 years) and with intravenous PCA in 33 patients (10-27 years). All narcotics and non-narcotics given up to the second postoperative day were evaluated. Total doses of narcotics were computed on a microgram per kilogram of body weight basis as morphine equivalents (ME) and total doses of non-narcotics, on a milligram per kilogram of body weight basis. Results: In the PRN group significant differences in postoperative analgesia between children and adults were detected, but there were no differences between younger and older children. The number of narcotic administrations was lower in children (4-16 years) than in adults (7 vs 12.1 analgetic doses;P<0.0001). In adults significantly higher total doses of narcotics were administered than in children (100.5 vs 67.8 μg/kg body weight ME;P<0.05). Treatment with nonnarcotics was not different between children and adults. In the second part of the study 43 patients in the PRN group, who had been treated with narcotics exclusively, were compared with the PCA group. Children with PCA had a significantly higher total consumption of narcotics than children in the PRN group (146.8 vs 74.4 μg/kg body weight ME;P<0.001). No differences in narcotic doses were found in adults with PCA and those with PRN medication. There was wide individual variation in the use of narcotics in PCA patients, but no differences between children and adults. Conclusion: Children received smaller quantities of narcotics than adults when postoperative analgesia was performed with PRN administration. PCA led to delivery of larger quantities of narcotic drugs than PRN medication in children.