Nurse-controlled analgesia for postoperative pain in pediatric patients: effects on nurses' attitudes and patient care

Background: Because of the limited number of patient-controlled analgesia (PCA) pumps in our developing country, we proposed a technique of modified nurse-controlled analgesia (NCA) to relieve postoperative pain in pediatric patients. Objective: We assessed efficacy, safety, compliance by nurses, and satisfaction including parent satisfaction of a modified NCA protocol compared with fixed-dose analgesia conventionally used for postoperative pain relief in pediatric patients. Methods: A prospective study design was conducted in pediatric patients who underwent major surgery in a university hospital. In the pre-NCA phase, patients received a conventional fixed-dose opioid after surgery. In the NCA phase, nurses could initiate two additional small doses autonomously, as prescribed, if the initial bolus was inadequate. Outcome measures were the number of moderate to severe pain scores, respiratory depression, compliance by nurses, and parent satisfaction. Results: There were 117 and 113 patients in the pre-NCA and NCA phases, respectively. Detection of moderate to severe pain >= 2 episodes in 24 h after surgery was significantly higher in the NCA phase especially in moderate to severe pain procedures. Respiratory depression was not found in either phase. The majority of nurses showed positive attitudes to routine use of a modified NCA protocol. Parent satisfaction was high in both groups. Conclusion: The attitude of nurses toward the modified NCA protocol was positive and it significantly increased detection of episodes of moderate to severe postoperative pain, which accordingly increased patient care and pain relief without severe untoward effects.