Page 120 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 11

Author: Wiffen PJ A1
Date: 02-12-2008
Question: Should PCA morphine vs. IM morphine be used in post-operative pain in children and
adolescents with a mean age of 13 years?
Settings: Children’s hospital, Boston, MA, USA.
Bibliography: Berde C et al. Patient controlled analgesia in children and adolescents: a randomized
prospective comparison with intramuscular administration of morphine for postoperative analgesia.
Journal of Pediatrics, 1991, 118:460–466.
A2
Summary of findings
Quality assessment
No. of patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations PCA morphine IM morphine Relative (95% CI) Absolute Quality A3

Patient pain scores (follow-up: 48 hours; achieved a VAS pain scale of at least mild pain)
1 Rand- No No Serious a No None 10/32 5/23 Not – MOD-
omized serious serious serious (31.3%) (21.7%) statistically ERATE
b
trial limita- incon- impre- significant A4 A4
tions sistency cision NNT 10 (-7
to 3)

Adverse events (follow-up: mean 48 hours; patient self report and nurse observation)
1 Rand- No No Serious a No None Descrip- Descrip- – – MOD-
omized serious serious serious tive data tive data ERATE
trial limita- incon- impre- only c only c
tions sistency cision A5

PCA, patient-controlled analgesia; IM, intramuscular; CI, confidence interval; VAS, visual analogue scale; NNT,
number needed to treat.
a Study of post-operative orthopaedic pain.
b Only PCA vs. IM data used. A third group included a baseline continuous infusion of morphine. Data excluded for
PCA plus as background infusion. Data extracted as reported.
c No respiratory depression in either groups. Sedation was less on PCA than on IM. No difference between the two A6
groups in nausea or return to gastrointestinal function. No difference between the two groups in urinary retention.

A7

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