A Randomized Controlled Trial of Early Oral Analgesia in Gynecologic Oncology Patients Undergoing Intra-Abdominal Surgery

Pearl, Michael L.; McCauley, Dayna L.; Thompson, Jill; Mahler, Linda; Valea, Fidel A.; Chalas, Eva

doi:10.1097/00006250-200205000-00007

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…Recently, Pearl et al provided evidence that early oral analgesia in gynecologic oncology patients undergoing intra-abdominal surgery is as safe and efficacious as intermediate intravenous PCA. 109 On the other hand, one must always keep in mind that some cancer patients with a long history of opioid use can develop serious postoperative problems if their previous opioid consumption is not taken into consideration, as demonstrated in a case report by Heid et al, where early PCA revealed a daily intravenous morphine need of 600-800 mg. 110 No articles have been published in the last 2 years on the use of PCA for the treatment of oral mucositis pain, a method that is nevertheless frequently used in many centers. Worthington et al, in a recent systematic review, described 3 trials that compared PCA to the continuous infusion method.…”

Section: Pca In Cancer Patientsmentioning

confidence: 99%

Recent Developments in Patient-Controlled Analgesia

Lehmann

2005

Journal of Pain and Symptom Management

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Patient-controlled analgesia (PCA) has become the gold standard for acute pain management since it was first introduced 20 years ago, and its merits have been discussed in quite a large number of publications. This review summarizes the more recent developments, such as new application devices and strategies, including intranasal, spinal, and regional PCA; patient-controlled sedation; experience with children and elderly people; and some data from chronic pain situations. Analyzing PCA literature from 2001 onwards confirms the author's long belief that the PCA principle ("WYNIWYG": what you need is what you get) was the most important aspect of a patient-controlled strategy, more or less independent of the type of drug or machine. Discovering this principle has changed the understanding of pain and suffering.

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Section: Pca In Cancer Patientsmentioning

confidence: 99%

Recent Developments in Patient-Controlled Analgesia

Lehmann

2005

Journal of Pain and Symptom Management

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“…No studies were found regarding the early administration of oral opioids in children. However, the early introduction of oral morphine to adult patients undergoing intra-abdominal surgery was found to be safe and efficacious (Pearl et al, 2002). Despite not using prophylactic antiemetics, the patients who began early oral opioids had no increase in nausea, vomiting, or abdominal distension compared with the parenteral pain medication group.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Little is known about when children are most likely to tolerate the transition from IV to oral opioids without vomiting. Nausea and/or vomiting (or even the fear of nausea/vomiting) may cause patients, parents, and even nurses to postpone the introduction of oral opioids, which may result in increased healthcare costs (Pearl et al, 2002). Currently, there is no protocol in place telling nurses when to administer the oral opioids once the order has been placed.…”

Section: Introductionmentioning

confidence: 99%

“…Multimodal pain management may include local anesthetic infiltration, patient-controlled analgesia (PCA) for the administration of intravenous (IV) opioids, and scheduled ketorolac until patients are able to tolerate oral opioids (Liu et al, 2013). Although necessary in patients unable to tolerate oral opioids, it stands to reason that PCA may be associated with increased opioid consumption, side effects (e.g., constipation, pruritus), monitoring, cost, and length of stay (Charoenkwan & Matovinovic, 2014; Pearl et al, 2002). Often, children are not transitioned from IV to oral opioids until they have shown the ability to tolerate oral fluids (e.g., clear liquids), which may cause prolonged use of IV opioids.…”

Section: Introductionmentioning

confidence: 99%

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Tolerance of Oral Opioid Medication After Surgery for Ruptured Appendicitis in Pediatric Patients

Wilson-Kocovsky

Sudar

2018

Journal of Pediatric Surgical Nursing

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Introduction: Each year, numerous children undergo surgery and require oral opioids during their postoperative recovery. Little is known about when children who have been on a nothing-by-mouth diet after surgery can tolerate oral opioids. Although oral opioids offer advantages over the intravenous route, healthcare professionals have differing opinions regarding how much oral intake (liquids or solids) a patient needs to tolerate before starting oral opioids. This could lead to inconsistencies in practice, which could impact patients' comfort, length of stay, and, ultimately, healthcare costs. The primary purpose of this study was to identify current practice regarding initiation of oral opioids in pediatric patients recovering from an appendectomy for ruptured appendicitis. On the basis of this data, our team aimed to provide a best practice recommendation for this population. Methods: A retrospective chart review was conducted from a sample of 43 children recovering from an appendectomy secondary to ruptured appendicitis. Data included time from surgery to ingestion of clear liquids, administration of oral opioids, and occurrence of emesis in relation to either of these administrations. Results: Children received from 30 ml to an average of 354 ml of clear liquids before taking oral opioids, and no patients had emesis documented regardless of the volume of clear liquids they ingested before administration of oral opioids. Discussion: Results suggest that pediatric patients may be able to tolerate oral opioids regardless of the amount of clear liquids they tolerate beforehand. Although more studies are needed to support these results, such results could mean earlier transition from intravenous to oral opioids, which could decrease healthcare costs and potentially decrease length of stay.

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“…Investigation has been more vigorous for out-patients on PCA, with the majority of patients being at the end of their life (Citron et al, 1992;Kerr et al, 1988;Meuret and Jocham, 1996;Schiessl et al, 2007Schiessl et al, , 2008aSwanson et al, 1989;Wagner et al, 1989). Other studies on PCA use in cancer patients have been restricted to dose finding (Zech et al, 1992;Baumann et al, 1986;Grond et al, 1997;Kornick et al, 2001;Radbruch et al, 1999), or postoperative pain control (Pearl et al, 2002).…”

Section: Introductionmentioning

confidence: 99%