Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery

Abstract

Estudo comparativo de duas diferentes modalidades de analgesia controlada pelo paciente após cirurgia cardíacaComparasion study of two different patientcontrolled anesthesia regiments after heart surgery Abstract Introduction: Acute and severe pain is frequent in patients who undergo heart surgery and patient controlled analgesia (PCA) can be used to manage postoperative pain.Objective: To compare analgesia using PCA without continous infusion with PCA plus a continuous infusion of morphine on postoperative period of heart surgery and to assess pain scores, morphine consumption, number of demand, patient satisfaction and side effects.Methods: Randomized clinical trial was performed to assess patients who had undergone heart surgery who received either PCA with and without intravenous infusion of morphine. In the postoperative period, PCA was started at extubation in both regiments according to randomization. Pain intensity, morphine consumption, number of demand, satisfaction and side effects were assessed at zero, six, twelve, eighteen, twenty four and thirty hours after patients' extubation.Results: The study enrolled 100 patients. 50 patients received PCA without continuous infusion of morphine (Group A), and 50 patients received morphine PCA plus a continuous infusion of morphine (Group B). Group B patients had less demand of morphine, consumed more morphine and were more satisfied regarding analgesia. No statistical differences were found between groups related to pain intensity, and side effects.Conclusions: Pain control was effective and similar in both groups. The same efficacy of analgesia and the less morphine consumption suggest that PCA without continuous infusion of morphine seems to be better option for postoperative pain manage in heart surgery. Descriptors 39MOTA, FA ET AL-Comparasion study of two different patientcontrolled anesthesia regiments after heart surgery Rev Bras Cir Cardiovasc 2010; 25(1): 38-44 less side effects and drug consumption after cardiac surgery. Thus, this randomized controlled study was carried out with the aim to compare these two regiments after cardiac surgery. METHODSThe study protocol was approved by the institutional ethical and research committee and patients were enrolled in the study after formal consent. The major eligibility criteria are listed in Table 1.

Efectividad de la analgesia controlada por el paciente en el dolor agudo y crónico de los pacientes después de cirugía cardiaca: estudio prospectivo

“…Estos valores medios indican que los requerimientos de los pacientes pueden variar mucho. Se registran requerimientos de analgesia de rescate en un 65 % de los pacientes (19). Este porcentaje es similar al 63 % de los pacientes del grupo de AC que precisaron analgesia de rescate, y mayor que las demandas analgésicas de rescate del grupo PCA, (63 % vs. 44 %, p = 0,0487).…”

“…Se han demostrado seguros en pacientes menores de 70 años y con función renal preoperatoria normal. Su uso durante un corto periodo de tiempo, en estos pacientes, no se ha asociado a mayor mortalidad, infarto de miocardio, disfunción renal o sangrado gastrointestinal (19,20).…”

A randomised trial of oral versus intravenous opioids for treatment of pain after cardiac surgery

“…Poorly controlled thoracic pain may contribute directly or indirectly to postoperative complications, including myocardial ischaemia, hypoventilation and atelectasis, delayed return of gastrointestinal function and decreased mobility [2,3]. There is also a strong association between prolonged acute pain and subsequent development of persistent incisional pain [4].…”

Manejo da dor pós-operatória em pacientes submetidos à mastectomia

“…No entanto, milhões de pacientes todos os anos sofrem de dor aguda como resultado de um trauma, doença ou cirurgia. Mesmo com os significativos avanços na área da fisiopatologia da dor, da farmacologia dos analgésicos e do desenvolvimento de novas técnicas para o controle da dor pós-operatória, muitos pacientes têm sua dor subavaliada e subtratada, recebendo tratamento inadequado, o que sinaliza para um dos problemas mais importantes no campo da cirurgia, com impacto significante em nosso sistema de saúde (WU; RAJA, 2011;MOTA et al, 2010;FU;YU, 2009).A dor é a razão mais comum para a admissão ao serviço de urgência, com 40% ou mais dos 100 milhões de atendimentos por ano e com uma grande proporção de casos envolvendo dor de intensidade moderada a grave. A prevalência de dor aguda intensa é igualmente elevada nos pacientes submetidos à cirurgia, representando um obstáculo à qualidade do cuidado (ARGOFF, 2011).…”

“…No entanto, milhões de pacientes todos os anos sofrem de dor aguda como resultado de um trauma, doença ou cirurgia. Mesmo com os significativos avanços na área da fisiopatologia da dor, da farmacologia dos analgésicos e do desenvolvimento de novas técnicas para o controle da dor pós-operatória, muitos pacientes têm sua dor subavaliada e subtratada, recebendo tratamento inadequado, o que sinaliza para um dos problemas mais importantes no campo da cirurgia, com impacto significante em nosso sistema de saúde (WU; RAJA, 2011;MOTA et al, 2010;FU;YU, 2009).…”