PCA in paediatric orthopaedic patients: influence of a NSAID on morphine requirement

Summary Ninety‐seven consecutive children (5‐16 years of age), who underwent a major orthopaedic operation received patient controlled analgesia (PCA) as their main therapy for postoperative pain. A Pharmacia Deltec TM pump was used with a bolus dose of 25 μg·kg −1 of morphine, a lock‐out period of 8 min, and a maximally delivered dose of 0.1 mg·kg −1 in an hour. Two‐thirds of the patients were allocated to receive a concomitant non‐steroidal anti‐inflammatory drug (NSAID), either ibuprofen 40 mg·kg −1 or diclofenac 2 mg·kg −1 daily. Individual morphine requirement varied greatly (range 0.1‐1.6 mg·kg −1 in a day) and could not be predicted preoperatively. It was 29% less in patients receiving a NSAID (0.53 ± 0.35 (SD) vs 0.75 ± 0.28 mg·kg −1 during the first postoperative day, P = 0.002). Patient's age did not influence morphine requirement, but patients with nausea took 23% less morphine than other patients ( P = 0.023). Postoperative nausea was more frequent in patients having a NSAID (52 vs 31%, P = 0.027). The principle of PCA made it possible to cover even a wide individual range of postoperative opioid requirement with great patient satisfaction.