Patient controlled analgesia: effective and cost‐effective management of acute pain within the Emergency Department?

Doleman, Brett; Williams, John P.

doi:10.1111/anae.13893

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…One of the clinical trials reported a serious adverse event attributed to respiratory depression in the PCA group [11], suggesting larger data-sets are required to identify potentially significant increases in respiratory depression within an ED population. Indeed, a previous study that used continuous pulse oximeter recordings has suggested a high incidence of desaturation episodes with opioid PCA and similar studies in an ED population would be welcomed [20].…”

Section: Safetymentioning

confidence: 95%

Widening the search for suspect data – is the flood of retractions about to become a tsunami?

Loadsman

McCulloch

2017

Anaesthesia

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Section: Safetymentioning

confidence: 95%

Widening the search for suspect data – is the flood of retractions about to become a tsunami?

Loadsman

McCulloch

2017

Anaesthesia

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“…Its clinical advantages are no longer to be demonstrated in the treatment of post-operative pain, which is why the idea of using PCA in emergency departments appeared, with scores comparable to intermittent IV boluses. Doleman et al and Pritchard et al compare PCA to standard treatment by studying not only the pain experienced but also the cost necessary to avoid moderate to severe pain [15,16]. Taking into account the different costs, PCA is about twice as expensive as conventional morphine administration.…”

Section: Drug Analgesic Strategy In Emergency Medicinementioning

confidence: 99%

Medico-economic study of pain in an emergency department: a targeted literature review

Deroanne

Gelas²,

Geffroy

et al. 2019

Journal of Market Access & Health Policy

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Background: Pain management in emergency departments is a complex objective. The absence of a care pathway or a high level of activity complicates diagnostic or analgesic therapeutic strategies. Medical innovation can impact both individual practices and the functioning of an emergency department.Objective: We then wanted to understand how medico-economic studies on pain were carried out in an emergency department.Study design: We reviewed the literature of the last 20 years (between 1998 and 2018).Setting: Of 846 titles screened, a total of 268 abstracts qualified for further screening, and 578 titles were excluded. A total of 14 studies qualified for inclusion in the review. Studies on medico-economics in an emergency department are very diverse. None of the methods used are identical; the studies differ in their very nature (prospective, retrospective, cost-effectiveness, etc.) and the determination of emergency room costs differs according to the part of the world studied. In addition, organizational impact is rarely measured, although it is an essential dimension for choosing or not a medical innovation.

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Patient-controlled analgesia morphine for the management of acute pain in the emergency department: a systematic review and meta-analysis

Oon,

Nik Ab. Rahman,

Mohd Noor

et al. 2024

Int J Emerg Med

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Background The ideal pain control approach is typically viewed as titration of analgesia for pain reduction and periodic pain evaluation. However, this method takes time and is not always possible in the crowded Emergency Department. Therefore, an alternative way to improve pain care in the Emergency Department is needed to avoid this unpleasant sensation in the patients. The best solution to tackle this situation is using Patient Controlled Analgesia (PCA), in the form of a PCA pump. Study objectives This systematic review and meta-analysis was designated to evaluate the efficacy of PCA morphine in treating acute pain at Emergency Department. Methods We searched databases Cochrane Central Register of Controlled Trials (CENTRAL), Medline, and Google Scholar up to February 2022 and identified randomized controlled trials with English language only that compare PCA morphine to IV morphine in treating patients presenting with acute pain at Emergency Department. Results Eight trials were included in our review, comprising 1490 participants. We compared PCA morphine vs. IV morphine. There were no differences in the pain score between PCA and IV morphine (standard mean difference [SMD] = -0.20, p = 0.25). Further subgroup analyses (origin of the pain, time of assessment and the durations) showed no difference except for the dosages as the PCA morphine reduced the pain compared to IV morphine in low and high dosages but only two studies were involved. However, the analysis showed PCA morphine increased patient satisfaction and reduced the number of patients who required additional analgesia compared to IV morphine (MD 0.12, P < 0.001), (MD 0.47, P < 0.001) respectively. Data obtained in this review pertaining to adverse effects such as nausea, vomiting, pruritus, and drowsiness is limited since not all the trials reported the events. Conclusions PCA morphine do appear to have a beneficial effect on the outcome of patient satisfaction and the number of patients who required additional analgesia. However, further studies targeting a larger sample size is required to increase the certainty of the evidence.

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Patient controlled analgesia: effective and cost‐effective management of acute pain within the Emergency Department?

Cited by 3 publications

References 19 publications

Widening the search for suspect data – is the flood of retractions about to become a tsunami?

Widening the search for suspect data – is the flood of retractions about to become a tsunami?

Medico-economic study of pain in an emergency department: a targeted literature review

Patient-controlled analgesia morphine for the management of acute pain in the emergency department: a systematic review and meta-analysis

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