Page 121 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 12

Author: Wiffen PJ
Date: 15-02-2010
Question: Should PCA morphine with background infusion vs. continuous morphine infusion be used
for post-operative pain in children?
Setting: Not stated.
Bibliography: Peters JWB et al. Patient controlled analgesia in children and adolescents: a randomised
controlled trial. Paediatric Anaesthesia, 1999, 9:235–241.

Summary of findings
Quality assessment
No. of patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations PCA morphine with background infusion a Continuous orphine infusion a Relative (95% CI) Absolute Quality

Mild pain at 2 days (follow-up: mean 2 days; daily mean pain scores (VASPI)
1 Rand- Serious b No Serious c No None 7/24 15/23 – – LOW
omized serious serious (29.2%) d (65.2%) d
trial incon- impre-
sistency cision
PCA, patient-controlled analgesia; CI, confidence interval; VASPI, visual analogue scale of pain intensity.
a Results are the number of patients who achieved “mild” pain on day 2. Results calculated from article’s Figure 1.
b No details of randomization or allocation concealment provided.
c Post-operative pain model not chronic pain.
d Doses: PCA morphine bolus of 15 mcg/kg lockout of 10 minutes and background of 15 mcg/kg/hr; continuous
morphine 20–40 mcg/kg/hr.

> 118