Evaluation of Quality in Patient-Controlled Analgesia Provided by an Acute Pain Service

Abstract

Institutions with quality management programs need to evaluate the quality of perioperative pain management as well as other aspects of the health service. With the development of anesthesia-based pain services, improvement in this field has been reported. In this prospective study performed in a university hospital, we used a Postoperative Pain Therapy Assessment Questionnaire to quantify the effectiveness of pain therapy and factors affecting the degree of satisfaction and also to pinpoint areas that need improvement. A total of 915 patients who received patient-controlled analgesia for postoperative pain were included in the study; it seems to be the largest patient population from a single hospital. Data were collected as part of the hospital’s quality improvement activities. By analyzing the questionnaires, we found that patients were satisfied with the pain therapy performed under the guidance of anesthesiologists, but predictors of satisfaction such as pain intensity and side effects (nausea, vomiting, constipation and difficulty in walking) decreased patient satisfaction considerably. Patients are aware of the fact that health care givers take postoperative care seriously and they do not want any untoward effects interrupting their postoperative care. They are trying to participate in the decision making and also to learn more about pain medicine.

The use of patient‐controlled epidural fentanyl in elderly patients*

“…This means that patients experienced postoperative pain at times, even though they had the ability to treat the pain. Our results agree with those of Karci [19] which showed that patients using PCA rarely medicate themselves sufficiently to achieve complete pain relief. However, patients' satisfaction with their analgesic control was high in both groups.…”

“…Whether a patient suffers adverse effects significantly impacts a patient's satisfaction with their postoperative analgesia [19]. Elderly and young patients consumed a comparable amount of fentanyl and, consequently, had similar incidences of side-effects such as pruritus, nausea, and drowsiness.…”

The Impact of Technology on the Analgesic Gap and Quality of Acute Pain Management

“…Uncontrolled pain not only leads to poorer perceptions of patient satisfaction with hospitalization but also may have negative consequences on functional mobility, emotional well-being, health-related quality of life, and overall recovery. 9,10 This situation may also influence a patient's decision to seek redress, should such a medical error occur. There is considerable evidence from systematic reviews and meta-analyses that technology-supported pain care, such as IV PCA and continuous epidural analgesia with or without patient-controlled epidural analgesia (PCEA), is associated with superior pain relief compared with intramuscular injections.…”

“…The results of 2 meta-analyses of published randomized, controlled comparative trials of conventional analgesia and IV PCA concluded that patients strongly preferred PCA over conventional analgesia. 10,35 However, IV PCA has several limitations because typical IV PCA pumps are bulky and costly, require tubing and batteries or power supplies, and mandate the use of prefilled medication cartridges or a pharmacist to fill syringes with an opioid under sterile conditions. 36 IV PCA also requires significant upfront and ongoing cost expenditures, and current numbers of health care personnel in many institutions may fall short of what is required to effectively and efficiently implement optimal postoperative pain control with this modality.…”