Recent Developments in Patient-Controlled Analgesia

Lehmann, K. A.

doi:10.1016/j.jpainsymman.2005.01.005

Cited by 68 publications

(41 citation statements)

References 185 publications

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“…This is contrary to a previous study done in a group of sickle cell disease patients in whom lower mean morphine consumption in the PCA group resulted in adequate pain relief and significantly less nausea and vomiting compared with the continuous infusion group during vaso-occlusive crises [13]. Recently this trend has changed, as consumption has been found to be equal or more compared to continuous infusion depending upon individual variability [6]. The fact that the amount of pethidine consumed was same in the two groups indicates the advantage offered to IV-PCA group patients, to take the dose of analgesia at the initial feeling of pain, leading to an improved analgesic profile with the same amount of opioid utilized.…”

Section: Discussioncontrasting

confidence: 67%

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Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Ismail¹,

Afshan²,

Monem³

et al. 2012

OJAnes

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Background: Management of postoperative pain after caesarean section (CS) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical Analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.

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Section: Discussioncontrasting

confidence: 67%

“…PCA works on the principle of individual variability of "what you need is what you get" (WYNIWYG) [6]. Since the total amount of pethidine consumed over 24 hours was the same in both groups, one explanation for improved pain control with PCA could be the timing of the doses.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Ismail¹,

Afshan²,

Monem³

et al. 2012

OJAnes

View full text Add to dashboard Cite

show abstract

“…1 Empirical research conducted over the past 20 years has demonstrated several advantages over conventional approaches to acute postoperative pain management. Patient-controlled analgesia is associated with a significant decrease in the incidence of moderate and severe pain after surgery compared with intramuscular opioids.…”

Section: Conclusion : L'utilisation Postopératoire Excessive De Morphmentioning

confidence: 99%

Locked out and still knocking: predictors of excessive demands for postoperative intravenous patient-controlled analgesia

Katz

Buis

Cohen

2008

Can J Anesth/J Can Anesth

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CAN J ANESTH 55: 2 www.cja-jca.org Februar y, 2008 Background: Psychosocial factors governing the use of postoperative, intravenous patient-controlled analgesia (PCA) have received little attention in spite of the fact that PCA is the most common modality for managing pain after surgery. The motivation behind requests for analgesia during lockout periods is not known. Unrelieved pain and need for pain medication are obvious reasons but other factors may be involved. The aim of the present study was to predict PCA lockout interval demands based on preoperative psychosocial factors.Methods: Approximately one week before major abdominal gynecologic surgery, 117 women completed the impact of events scale (IES) measuring intrusive thoughts and avoidant behaviours. Pain was measured by visual analogue scale at three, six, 12, 24 and 48 hr after surgery. Measures of anxiety and negative affect were obtained 24 and 48 hr after surgery. Cumulative morphine consumption and every PCA demand (drug delivered and not delivered) were downloaded from the PCA pump.Results: Multiple regression analyses revealed that preoperative intrusive thoughts and avoidant behaviours about the upcoming surgery positively predicted PCA lockout interval demands after controlling for postoperative pain, morphine consumption, anxiety, and negative affect (R 2 = 0.45; P < 0.0001). Path analysis showed a direct pathway from preoperative IES scores to lockout interval demands (β = 0.23, P = 0.002) which was not associated with untreated pain, anxiety, or negative affect. Conclusions:Excessive demands for postoperative intravenous-PCA morphine during lockout intervals appear to reflect, in part, poor preoperative adaptation to surgery involving intrusive thoughts and avoidant behaviours about the upcoming surgery.

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“…In den 3 verfügbaren pädiatrischen Stu dien erweist sich die PCA jedoch als ei [15,23]. Dies wird durch ei ne aktuelle CochraneAnalyse belegt und entspricht den Erkenntnissen zum opio idsparenden Effekt der PCA in der post operativen Schmerztherapie [9,20].…”

Section: Pca Zur Schmerztherapie Bei Mukositisunclassified

Zirkadianer Rhythmus des PCA-gesteuerten Opioidverbrauchs bei Kindern mit chemotherapiebedingter Mukositis

Schießl

Schestag

Grießinger

et al. 2008

Schmerz

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PCA seems to be an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose in children with chemotherapy-induced mucositis. This is expressed through the increase in daily self-administered opioid doses after starting PCA, the huge interindividual variability in opioid consumption and the rare event of an un-delivered bolus request during lock-out time. With the use of a background infusion, additional bolus requests are rare during the night.

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Recent Developments in Patient-Controlled Analgesia

Cited by 68 publications

References 185 publications

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion

Locked out and still knocking: predictors of excessive demands for postoperative intravenous patient-controlled analgesia

Zirkadianer Rhythmus des PCA-gesteuerten Opioidverbrauchs bei Kindern mit chemotherapiebedingter Mukositis

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