McDonald A J, Cooper M G
Vincent Fairfac Pain Unit, The Children's Hospital at Westmead, New South Wales, Australia.
Paediatr Drugs. 2001;3(4):273-84. doi: 10.2165/00128072-200103040-00004.
Patient-controlled analgesia (PCA) is an analgesic technique originally used in adults but now with an established role in paediatric practice. It is well tolerated in children as young as 5 years and has uses in postoperative pain as well as burns, oncology and palliative care. The use of background infusions is more frequent in children and improves efficacy; however, it may increase the occurrence of adverse effects such as nausea and respiratory depression. Monitoring involves measurement of respiratory rate, level of sedation and oxygen saturation. Efficacy is assessed by self-reporting, visual analogue scales, faces pain scales and usage patterns. This is optimally performed both at rest and on movement. The selection of opioid used in PCA is perhaps less critical than the appropriate selection of parameters such as bolus dose, lockout and background infusion rate. Moreover, opioid choice may be based on adverse effect profile rather than efficacy. The concept of PCA continues to be developed in children, with patient-controlled epidural analgesia, subcutaneous PCA and intranasal PCA being recent extensions of the method. There may also be a role for patient-controlled sedation. PCA, when used with adequate monitoring, is a well tolerated technique with high patient and staff acceptance. It can now be regarded as a standard for the delivery of postoperative analgesia in children aged >5 years.
患者自控镇痛（PCA）是一种最初用于成人的镇痛技术，但现在在儿科实践中也已确立了其作用。5岁及以上的儿童对其耐受性良好，它可用于术后疼痛以及烧伤、肿瘤学和姑息治疗。儿童使用背景输注更为频繁，这可提高疗效；然而，它可能会增加恶心和呼吸抑制等不良反应的发生。监测包括测量呼吸频率、镇静水平和血氧饱和度。疗效通过自我报告、视觉模拟量表、面部疼痛量表和使用模式进行评估。这在休息和活动时进行最为理想。PCA中使用的阿片类药物的选择可能不如适当选择诸如单次给药剂量、锁定时间和背景输注速率等参数那么关键。此外，阿片类药物的选择可能基于不良反应情况而非疗效。PCA的概念在儿童中仍在不断发展，患者自控硬膜外镇痛、皮下PCA和鼻内PCA是该方法最近的扩展。患者自控镇静可能也有作用。当进行充分监测时，PCA是一种耐受性良好的技术，患者和医护人员的接受度很高。现在它可被视为5岁以上儿童术后镇痛的标准方法。
