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PEDIATRIC ANESTHESIA

The Safety of Patient-Controlled Analgesia by Proxy in Pediatric Oncology Patients

Doralina L. Anghelescu, MD^*, Laura L. Burgoyne, BM, BS, FANZCA^*, Linda L. Oakes, RN, MSN, CCNS, and Debora A. Wallace, RN, BSN^*

Division of *Anesthesia and Nursing Research and Patient Care Services, St. Jude Children’s Research Hospital, Memphis, Tennessee

Address correspondence and reprint requests to Doralina L. Anghelescu, MD, Division of Anesthesia, Mail Stop 130, St. Jude Children’s Research Hospital, 332 North Lauderdale St., Memphis, TN 38105-2794. Address e-mail to doralina.anghelescu{at}stjude.org.

Between February 1999 and December 2003, we studied the use of patient-controlled analgesia (PCA) to control pain in 1011 children and young adults with cancer, by evaluating 4972 24-h periods of PCA usage, 576 of which involved PCA by proxy. Selection of patients for PCA by proxy was based on younger age group, neuromuscular limitation, expectation of repeated painful procedures, and terminal disease. We measured the incidence of respiratory and neurological complications related to the use of PCA. Major complications were observed during 70 of the 4972 24-h observations, with 28 of 4972, or 0.56%, involving respiratory complications, 35 of 4972, or 0.7%, involving neurological complications, and 7 of 4972 24-h observations, or 0.14%, involving both respiratory and neurological complications. In the PCA by proxy group, two respiratory complications and two neurological complications were observed. Reversal of opioid-related respiratory or neurological effects with naloxone was required in three instances, two in the standard PCA group and one in the PCA by proxy group. Recommendations to ensure continuing safety include careful patient selection, education of proxy users, appropriate documentation, and institutional guidelines.

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