A randomized, prospective trial of
patient-controlled analgesia (PCA), that is, a method of
analgesia administration involving a computer-driven pump activated by patients to receive small doses within defined limits was performed in 82 children and adolescents after major
orthopedic surgery to compare (1) intramuscularly administered
morphine, (2) PCA
morphine and (3) PCA
morphine with a low-dose continuous
morphine infusion (PCA-plus). Patients receiving PCA and PCA-plus had lower
pain scores and greater satisfaction than patients receiving intramuscularly administered
morphine. The three groups used equal amounts of
morphine and most measures of recovery were identical in the groups. In particular, PCA and PCA-plus did not increase the incidence of
opioid-related complications, and patients receiving PCA-plus were less sedated than patients receiving intramuscular
therapy. We conclude that PCA and PCA-plus are safe and effective methods of
pain relief in children and adolescents after
orthopedic surgery, are better accepted than
intramuscular injections, and do not increase perioperative morbidity.