L’analgésie contrôlée avec patience: vers une meilleure compréhension des comportements d’auto-administration des analgésiques

Gilron, Ian

doi:10.1007/bf03016318

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…In addition to reports of pain intensity, we examined the PCA injection: attempt ratio. This ratio has been used in the pain literature as a behavioral indicator of anxiety or distress, and as an index of pain control, with both increasing injections and attempts possibly indicating uncontrolled pain 11,23 . The similarity of the PCA injection: attempt ratio between groups, suggests that the additional opioid used in the morphine group was not a result of additional PCA injections alone.…”

Section: Discussionmentioning

confidence: 99%

“…11,23 The similarity of the PCA injection: attempt ratio between groups, suggests that the additional opioid used in the morphine group was not a result of additional PCA injections alone. Rather, our findings suggest that for the morphine group, F I G U R E 3 n (%Note: Data represent number of patients treated for each side effect listed (%), collapsed across POD.…”

mentioning

confidence: 95%

“…The primary outcome was total postoperative opioid consumption across postoperative days (POD) 0–3. Secondary outcomes included postoperative pain severity, ratio of patient‐controlled analgesia (PCA) injections to attempts (as a behavioral index of uncontrolled pain), 11 and opioid‐related side effects (itching, vomiting, need for supplemental oxygen, sedation, respiratory depression, urinary retention, and time to first bowel movement). We hypothesized that in contrast to morphine, intraoperative methadone would result in a reduction of postoperative opioid use, improved pain control (evidenced as lower pain severity and a higher PCA injection: attempt ratio), and fewer opioid‐related side effects.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative methadone for posterior spinal fusion in adolescents: Results from a double‐blind randomized‐controlled trial

Fons,

Hainsworth,

Michlig

et al. 2024

Pediatric Anesthesia

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BackgroundPosterior spinal fusion is the most common surgical procedure performed for correction of adolescent idiopathic scoliosis in the United States. Intraoperative methadone has been shown to improve pain control in adult patients undergoing complex spine surgery, and current pediatric studies show encouraging results; however, prospective randomized‐controlled trials are lacking in the pediatric literature.AimsWe conducted a single‐center double‐blind randomized‐controlled trial to compare intraoperative use of methadone to morphine in pediatric patients undergoing posterior spinal fusion.MethodsA total of 47 adolescents undergoing posterior spinal fusion were randomized (stratified by sex) to either a methadone (n = 25) or morphine (n = 22) group. The primary outcome was postoperative opioid consumption. Secondary outcomes included postoperative pain severity, opioid‐related side effects, and ratio of patient‐controlled analgesia injections: attempts as a behavioral index of uncontrolled pain.ResultsPatients in the methadone group consumed less total opioid postoperatively (median [interquartile range], 0.3 mg/kg [0.1, 0.5]) than patients in the morphine group (0.3 mg/kg [0.2, 0.6]), median difference [95% confidence interval] −0.07 [−0.2 to 0.02]; (p = .026). Despite the lower amount of opioid used postoperatively, pain scores for the methadone group (3.5 [3.0, 4.3]) were not significantly different from those in the morphine group (4.0 [3.2, 5.0]; p = .250). Groups did not differ on opioid‐related side effects.ConclusionsA two‐dose intraoperative methadone regimen resulted in decreased opioid consumption compared to morphine. Although the clinical significance of these results may be limited, the analgesic equipoise without increased opioid‐related side effects and potential for a lower incidence of chronic pain may tip the balance in favor of routine methadone use for adolescents undergoing posterior spinal fusion.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Perioperative methadone for posterior spinal fusion in adolescents: Results from a double‐blind randomized‐controlled trial

Fons,

Hainsworth,

Michlig

et al. 2024

Pediatric Anesthesia

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Stress Numerical Rating Scale-11: Validation in Pediatric Inpatient and Outpatient Pain Settings

LiaBraaten¹,

Linneman²,

Czarnecki³

et al. 2023

Pain Management Nursing

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Investigating the Effects of Cuing Medication Availability on Patient-controlled Analgesia Pump Usage in Pediatric Patients

Hainsworth

Czarnecki

Simpson

et al. 2020

The Clinical Journal of Pain

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Objectives: The study of patient-controlled analgesia (PCA) behaviors has led to a greater understanding of factors that affect the pain experience. Although PCA behaviors can be influenced by cues to medication availability, no studies have examined the effects of such cues in pediatric populations. Materials and Methods: This randomized controlled trial examined patient satisfaction with pain management, PCA behaviors, opioid consumption, and state anxiety in a sample of 125 postsurgical children and adolescents (7 to 17 y). Patients were randomized to a “light” group (lockout period status cued by light on the PCA button) or control group (no cues to medication availability). Results: Although cuing did not affect patient satisfaction with pain management (P=0.11), patients in the light group consumed significantly more opioid than those in the control group (adj. P=0.016). This effect was primarily because of children in the light group (median, 0.019; interquartile range, 0.012 to 0.036 mg/kg/h) consuming more opioid than children (12 y or younger) in control group (median, 0.015; interquartile range, 0.006 to 0.025 mg/kg/h) (P=0.007). In contrast to the control group, for patients in the light group, opioid consumption was unrelated to pain and the proportion of patients with a 1:1 injections:attempts ratio was higher (P<0.001) across the study period. Discussion: The overall pattern of results suggests that patients in the light group used their PCA in response to the light more than in response to their pain, which likely reflects operant influences on PCA behavior by pediatric patients.

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L’analgésie contrôlée avec patience: vers une meilleure compréhension des comportements d’auto-administration des analgésiques

Cited by 3 publications

References 26 publications

Perioperative methadone for posterior spinal fusion in adolescents: Results from a double‐blind randomized‐controlled trial

Perioperative methadone for posterior spinal fusion in adolescents: Results from a double‐blind randomized‐controlled trial

Stress Numerical Rating Scale-11: Validation in Pediatric Inpatient and Outpatient Pain Settings

Investigating the Effects of Cuing Medication Availability on Patient-controlled Analgesia Pump Usage in Pediatric Patients

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