<p><strong>BACKGROUND: </strong>Although patient-controlled analgesia (PCA) is an effective pain control modality, there is a lack of large studies on PCA safety in pediatric patients. This study compared the delivery of morphine either via intravenous route (morphine IV) or via PCA device (morphine PCA) on risk of cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV) using a large administrative database.</p>

<p><strong>METHODS: </strong>We assembled a retrospective cohort of pediatric inpatients between 5 and 21 years old in 42 children's hospitals between 2007 and 2011 from the Pediatric Health Information System. After propensity score matching, we created matched cohorts of morphine PCA and morphine IV patients, in both surgical and non-surgical samples, who were similar on demographic, clinical, and hospital-level factors. We examined if PCA administration was associated with greater likelihood of CPR or MV up to 2 days after drug administration.</p>

<p><strong>RESULTS: </strong>Surgical and non-surgical patients administered morphine PCA generally had lower odds of having MV on the baseline day and up to 2 days after PCA exposure, though these estimates were not statistically significant. Similarly, PCA exposure was associated with about 20-44% lower odds of same day CPR in both surgical and non-surgical patients, with a slightly greater reduction in the odds of CPR in the surgical patients.</p>

<p><strong>CONCLUSION: </strong>In this large pediatric inpatient population, morphine administered via PCA device for surgical and non-surgical pain was not associated with an increased risk of receiving CPR or MV, and was associated with slightly better safety outcomes than intravenous morphine.</p>