Current and Developing Methods of Patient-Controlled Analgesia

Palmer, Pamela Pierce; Miller, Ronald D.

doi:10.1016/j.anclin.2010.08.010

Cited by 79 publications

(76 citation statements)

References 53 publications

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“…Finally, routine basal infusion of opioids with PCA must be avoided in opioidnaive patients because it increases the risk of side effects (9,(13)(14)(15)(16). Opioid-related side effects are in fact numerous, and include hypotension, respiratory depression, itching, nausea and vomit, bowel ileus, confusion and sedation (16,17). For these reasons, whenever possible, the use of opioids should be avoided or at least reduced to enhance recovery after VATS lobectomy.…”

Section: Opioidsmentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary approach to surgical patients with the aim of enhancing the quality of recovery after surgery (1,2). This strategy translates into faster post-operative recovery and improvements of outcomes. All the ERAS Society guidelines (freely available at www.erassociety.org) take into consideration the perioperative management of analgesia. The role of pain management in ERAS pathways is fundamental, considering the importance of containing surgical stress, reducing pain-related complications and speeding recovery (2-5). Correspondence to: Carlo Del Naja, MD. Casa Sollievo della Sofferenza Hospital, viale Cappuccini, 1, 71013 San Giovanni Rotondo (FG), Italy.Email: c.delnaja@operapadrepio.it.Abstract: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

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Section: Opioidsmentioning

confidence: 99%

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Piccioni¹,

Segat²,

Falini³

et al. 2018

J. Thorac. Dis.

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“…The patients in this study received postoperative IV paracetamol, rectal morniflumate, and IV nalbuphine infusion. However, the pain management in the postoperative period is recommended to evaluate using the PCA method, because IV PCA provides superior pain relief compared with conventional on-demand analgesia (22,23). In the second study, morphine consumption within 72 hours was evaluated using IV PCA without postoperative ketamine infusion, and it was found that perioperative infusion affected neither postoperative pain scores nor opioid consumption.…”

Section: Discussionmentioning

confidence: 99%

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery?

Biçer¹,

Etı²,

Saraçoğlu³

et al. 2014

Turk J Anesth Reanim

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Original Article / Özgün Araştırma 320 Amaç: Tek doz intravenöz bolus uygulama, postoperatif veya peroperatif infüzyon yoluyla verilmesi ketaminin en çok tercih edilen uygulama yöntemlerindendir. Bununla beraber, ideal ketamin uygulama yöntemi konusunda net bir konsensus bulunmamaktadır. Bu çalışmada, en sık kullanılan ketamin uygulama yöntemleri ve zamanlarının postoperatif opioid tüketimi üzerine olan etkilerini karşılaştırmayı amaçladık.Yöntemler: Kolon kanseri için kolektomi ameliyatı geçirecek 52 hasta randomize olarak 4 gruba ayrıldı. Grup 1 kontrol grubuydu. Grup 2 indüksiyonda 0,5 mg kg -1 tek bolus doz intravenöz ketamin aldı. Grup 3 indüksiyonda 0,5 mg kg -1 bolus intravenöz ketamini takiben 0,25 mg kg -1 sa -1 hızda peroperatif intravenöz ketamin infüzyonu aldı. Grup 4 indüksiyonda 0,5 mg kg -1 bolus intravenöz ketamini takiben 0,25 mg kg -1 sa -1 hızda peroperatif ve postoperatif dönemde intravenöz ketamin infüzyonu aldı. Postoperatif ağrı skorları, yan etkiler ve morfin tüketimleri kaydedildi. Bulgular:Postoperatif ağrı skorlarında istatistiksel olarak anlamlı bir fark yoktu. Grup 4'de diğer gruplarla karşılaştırıldığında toplam morfin tüketimi daha az bulundu (p=0,03, p=0,004, p=0,03, gruplarda sırasıyla). Postoperatif 1, 2 ve 4. saatlerde hasta kontrollü analjeziyle morfin tüketimi Grup 4'de kontrol grubundan anlamlı olarak daha düşüktü (p<0,01).Sonuç: Preoperatif tek bolus doz yada intraoperatif düşük doz ketamin infüzyonu postoperatif morfin tüketimini azaltmamış-ken, per-ve postoperatif 48 saatlik ketamin infüzyonu uygulaması büyük abdominal cerrahi geçiren hastalarda yan etki insidansını artırmadan morfin tüketiminde anlamlı bir azalmayla sonuçlan-mıştır.Anahtar Kelimeler: Ketamin, postoperatif analjezi, kolektomi, morfin Objective: Single intravenous bolus administration and postoperative or perioperative infusions are the most preferred methods of ketamine. Nevertheless, there is no clear explanation on the ideal ketamine administration method. In this study, we aimed to compare the effects of the most common ketamine administration methods and administration time on postoperative opioid consumption. Methods:Fifty-two patients undergoing colectomy for colon cancer were randomly assigned into four groups. Group 1 was the control group. Group 2 received only a single intravenous bolus dose of 0.5 mg kg -1 ketamine at induction. Group 3 received 0.5 mg kg -1 intravenous ketamine bolus at induction and perioperative ketamine infusion at a rate of 0.25 mg kg -1 h -1. Group 4 received a bolus of 0.5 mg kg -1 intravenous ketamine at induction and perioperative and postoperative ketamine infusion at a rate of 0.25 mg kg -1 h -1. Postoperatively, visual analogue scale pain scores, side effects, and morphine consumption were recorded.Results: There was no statistically significant difference in postoperative pain scores. Total morphine consumption was found to be significantly lower in Group 4 compared to the other groups (p=0. 03, p=0.004, p=0.03, respectively). During the 1 st , 2 nd , and 4 th hour...

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“…The analgesia controlled by the patient offers a range of advantages compared with the common analgesia, some of them are 32 : improved analgesia, early relief of pain, more satisfaction and safety when compared with fixed doses of opioid. Although its benefits are well-defined, this analgesia method is still not available in most national institutes owing to cost.…”

Section: Discussionmentioning

confidence: 99%

Eficácia analgésica pós-operatória de diferentes volumes e massas de ropivacaína no bloqueio de plexo braquial pela via posterior

Morais¹,

Cruvinel²,

Carneiro³

et al. 2012

Rev. Bras. Anestesiol.

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18 anos, estado físico ASA I e II, escalados para cirurgias artroscópicas de ombro unilateral foram alocados aleatoriamente em três grupos: A (10 mL a 0,5%), B (20 mL a 0,5%), C (5 mL a 1%). O bloqueio foi realizado com agulha 22G de 100 mm conectada ao neuroestimulador, em um ponto 3 cm lateral ao ponto médio do interespaço de C6 e C7, sendo injetada a solução correspondente a cada grupo. A dor pós-operatória foi avaliada na SRPA e nas primeiras 24 horas do pós-operatório. Os grupos foram comparados quanto ao tempo para primeira queixa de dor, à pontuação na ENV e ao consumo de morfina nas primeiras 24 horas. RESULTADOS: Não houve diferença estatisticamente significativa entre os três grupos em relação a idade, peso e altura. Não houve diferença no tempo até a primeira queixa de dor, ENV superior a três e consumo de morfina no pós-operatório entre os grupos. CONCLUSÕES: O presente estudo concluiu que 5 mL de ropivacaína 1% promoveu eficácia analgésica similar a 10 mL ou 20 mL de ropivacaína 0,5% no bloqueio do plexo braquial pela via posterior com o uso do neuroestimulador]]>

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Current and Developing Methods of Patient-Controlled Analgesia

Cited by 79 publications

References 53 publications

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

Does the Method and Timing of Intravenous Ketamine Administration Affect Postoperative Morphine Requirement After Major Abdominal Surgery?

Eficácia analgésica pós-operatória de diferentes volumes e massas de ropivacaína no bloqueio de plexo braquial pela via posterior

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