Comparison of morphine patient-controlled analgesia with and without ketorolac for postoperative analgesia in pediatric orthopedic surgery.

The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study was to determine whether the administration of intravenous ketorolac, coadministered with morphine patient-controlled analgesia (PCA), demonstrates an opioid-sparing effect, provides improved analgesia, and reduces the incidence of opioid-induced side effects in children after orthopedic surgery. The findings of enhanced analgesia with decreased opioid use suggest that coadministration of ketorolac with morphine PCA is beneficial for the treatment of pain in children after orthopedic surgery.

Inadequate pain management and associated morbidity in children at home after tonsillectomy.

A telephone interview with the parents of 84 children who underwent tonsillectomy was conducted within 24 hours after discharge from an ambulatory surgery center. Parents were asked to rate the intensity of their child's pain and data were collected on the type, dose, and amount of analgesics administered, and the types of side effects the children experienced. The mean age of the children was 7 years (SD = 2.31), with an equal number of boys and girls. Overall mean pain intensity was 1.42 (SD = 0.71) and the worst pain intensity ranged from 0 to 3 (Mean = 1.93; SD = 0.83). Acetaminophen with codeine was the most common analgesic prescribed and administered. Children received an average of 3 doses in the first 24 hours after surgery. Seventy-seven percent of the parents stated that pain relief from the analgesic was adequate. Of the 23% who did not feel that pain control was adequate, only 7% contacted a physician. The majority of the children experienced restless sleep (62%), behavior changes (75%), and difficulty taking oral fluids because of complaints of pain (56%). Twenty-six percent of the children had one or more episodes of emesis. Our data suggest that children experience a significant amount of pain in the first 24 hours after tonsillectomy and that parents administer analgesics less frequently than the drugs are prescribed. In addition, children experience significant deleterious effects (i.e., poor oral fluid intake, sleep disturbance, behavioral changes, and emesis) associated with the undertreatment of pain, the analgesic administered, or the surgery itself.

The problem of pain in children with cancer: a research review.

Pain in a child with cancer poses significant challenges for nurses. However, little research has been conducted in the area of pediatric cancer pain to guide clinical assessments and interventions. The purpose of this paper is to present a review of the research studies conducted on pediatric cancer pain over 13-1/2 years. The review of the cancer pain research studies is organized around several concepts that include approaches to cancer pain assessment and management as well as the presentation, incidence, and etiology of pain associated with childhood malignancy. Relevant clinical findings from the review of the literature are highlighted. Emphasis is on the major nursing implications from these studies, and suggestions are made for future nursing research.

Comparison of the antinociceptive and motor effects of intrathecal opioid agonists in the rat.

This study compared the antinociceptive and motor effects produced by intrathecal administration of selective mu-, delta-, and kappa-opioid receptor agonists in the rat. Changes in nociceptive threshold were measured using the Randall-Selitto paw-withdrawal test and changes in motor coordination were evaluated using the rotarod treadmill test. Each opioid agonist produced statistically significant, dose-dependent increases in mechanical nociceptive thresholds compared to vehicle controls. In the motor coordination studies, DAMGO and DPDPE, but not U50,488H, produced statistically significant decreases in rotarod performance scores compared to vehicle controls. The results of these studies suggest that motor side-effects produced by opioid agonists need to be considered when interpreting the results of antinociceptive tests that are dependent on a normally functioning motor system.

Analgesic synergy and improved motor function produced by combinations of mu-delta- and mu-kappa-opioids.

This study evaluated the effects of intrathecal administration of a low-analgesic dose of the selective mu-agonist DAMGO co-administered with sequentially increasing doses of either the selective delta-agonist DPDPE or the selective kappa-agonist, U50,488H on mechanical nociceptive thresholds in the rat. Potent analgesic synergy was observed with both combinations. Since an elevation in nociceptive threshold can result from motor deficits, as well as true analgesia, we also evaluated the effects of the combination regimens on motor coordination using a rotarod apparatus. The combination regimens produced significantly less motor deficits than those observed when DPDPE and U50,488H were administered as single agents. These findings of enhanced analgesia with decreased motor side-effects associated with administration of fixed mu/delta or mu/kappa combinations suggest that co-administration of opiates that act at different receptors may constitute a superior approach to the treatment of pain.