Jan Cernovsky, M.D.

DEPARTMENT OF Anesthesiology
Keywords: osteotomy, bolus, morphine, patient-controlled analgesia

Osteotomies and other major orthopaedic surgeries can cause children to suffer from severe post-operative pain. Post-operative care typically takes place on the general care floor, where there is no immediate pain management team available. The patient is dependent on intravenous medication (morphine) delivered by staff on an “as needed” basis. Patients are sometimes reluctant to express the need for pain medicine and leave it until pain increases further or becomes unbearable. In addition, the plasma concentration of morphine after the bolus increases rapidly and provides the patient with pain relief, but this increases the incidence of side effects -- possible respiratory depression, nausea, vomiting, pruritus, etc.

Another method of pain medication delivery is the PCA (patient controlled analgesia) system for pos-operative patients. This provides the patient with a continuous morphine infusion and also gives the patient the possibility of independent pain management control. The patient may push a button to administer a bolus dose when needed (breakthrough pain, prior to therapy, etc.). The PCA machine has a lockout time that prevents the patient from receiving too many boluses too quickly. PCA safety is provided by a combination of administrating the correct bolus for given patient (minimizing the drug dose error possibility) and by a safety mechanism that ensures that the interval between the boluses is maintained despite repeated requests.

Our goal in this study is to compare the two current methods of pain medication (morphine) delivery in post-operative orthopaedic surgery patients. Patients using patient-controlled analgesia (PCA) will be compared to patients receiving IV bolus doses of pain medicine administered by the medical staff. Factors compared will be length of hospital stay, time to postoperative oral intake, and time to start of oral pain killer treatment.