Development of a monitoring protocol for safe use of opioids in children

A monitoring protocol incorporating pulse oximetry was developed for children receiving patient-controlled analgesia (PCA) and was applied to 75 children undergoing major abdominal, urological or orthopaedic procedures. Patients used PCA for a mean of of 48.9 h (range 11–147 h). Eighty-three percent of hourly pain scores were 0 or 1, indicating no pain or mild pain, with only 1.7% of 3669 recorded pain scores indicating severe pain. The mean minimum oxyhaemoglobin saturation (Spo₂) value while breathing ambient air was 92% (range 84–99%). Eighty-four percent of Spo₂ recordings were in the range 95–100%. Only 1% of Spo₂ recordings were <90% and none of these was associated with a slow respiratory rate or oversedation. The mean minimum respiratory rate was 17 (range 10–26). The protocol proved to be easy to use in the general ward. It can be readily adapted for use in all children receiving opioids by whatever route and for children undergoing sedation for investigative procedures.