How effective is patient-controlled analgesia? A randomized comparison of two protocols for pain relief during oocyte recovery

Abstract

Although the conventional method of pain relief during outpatient oocyte recovery involves physician-administered drugs, patient-controlled analgesia (PCA) offers an alternative technique with the potential to give women more control over peroperative analgesia. We conducted a prospective randomized study to compare the effect of fentanyl administered either through a PCA delivery system or by a physician. Thirty-nine women were randomized to PCA during egg collection while 42 were allocated to receive intermittent doses administered by a physician. Pain was evaluated by means of a 100 mm linear analogue scale. The mean (SD) pain score in the PCA group was 38.5 (19.8) while in the other group it was 46.1 (21.3) (P = 0.1). In the PCA group, 64% of women felt very satisfied with their analgesia as compared with 57% in the non-PCA group (P = 0.6). Among the PCA users, 39% of demands were successful. Significantly more fentanyl (97.5 microg) was used in the PCA group than in the other group (84.6 microg) (P = 0.03). Though intraoperative PCA with fentanyl is an effective alternative to physician-administered techniques, many women still feel the need for more analgesia during the procedure.

A randomised controlled trial of intravenous versus inhalational analgesia during outpatient oocyte recovery

“…Interestingly, pain scores and satisfaction rates in both arms of this trial showed an improvement over those in a previous study comparing conventional intravenous with patient‐controlled intravenous analgesia [3] in which no anaesthetist was present at oocyte retrieval. Although not directly responsible for the administration of either the intravenous or the inhalational analgesia in this study, the presence of the anaesthetist may have been perceived as an added source of support for these women.…”

“…A previous study [3] demonstrated that 57% of women undergoing oocyte recovery using the conventional regimen of intermittent intravenous analgesia were ‘very satisfied’ with their pain relief. This study aimed to recruit a total of 112 women to yield 80% power of detecting, at the 5% significance level, a 25% difference (between 60 and 85%) in satisfaction rates.…”

“…In the UK, the commonest method of pain relief for this procedure is intravenous sedation [1], often administered by the surgeon performing the procedure. A previous study has evaluated the benefits of patient‐controlled analgesia and highlighted the need for further improvement of analgesic techniques in this setting [3]. An ideal agent is one which is effective, safe, easy to administer, short‐acting and readily reversible.…”

Acupuncture in IVF: A review of current literature

“…Th ese are paracervical block (Ng et al 2003), conscious sedation (Bhattacharya et al 1997), epidural (Martin et al 1999) and general anaesthesia (Gonen et al 1995). Since the fi rst RCT on the anaesthetic eff ect of acupuncture in IVF (Stener-Victorin et al 1999), further studies have shown that acupuncture can be used safely as an adjunct for pain relief during ultrasound-guided oocyte aspiration.…”

Risques de la stimulation ovarienne et du prélèvement ovocytaire

“…L'efficacité antalgique de cette technique semble satisfaisante [26]. La pompe analgésique autocontrôlée (PCA) apporte elle aussi une bonne qualité de confort au cours de la ponction [27]. Nonobstant, la simple sédation et la pompe analgésique autocontrôlée peuvent provoquer une apnée ou une hypoxie, à l'occasion d'un surdosage morphinique.…”