Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization

Lipszyc, M.; Winters, Erik; Engelman, Edgard; Baurain, Michel; Barvais, Luc

doi:10.1093/bja/aer041

Cited by 15 publications

(5 citation statements)

References 24 publications

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“…The natural history of PI associated with UAE is that it remains severe during and for several hours after UAE and then decreases in intensity [4]. This has been reflected in other studies [15] that have measured the pattern of opioid use in the 24 h after UAE, and also in our study where mean PCA opioid across both groups was much less in the 6 to 24 h period (6.28 mg) compared to the 0 to 6 h period (14.9 mg). We also provided an oral dose of oxycodone which should have provided a peak concentration at approximately 3.2 h [21,22], theoretically matching the time period of peak analgesic requirement.…”

Section: Discussionsupporting

confidence: 61%

“…Previous studies [14][15][16] showed that morphine PCA provided superior PI ratings after UAE in a nonrandomized setting compared with fentanyl PCA [16]. In the remaining randomized controlled studies, morphine PCA was associated with greater early PI compared with target-controlled remifentanil [15] and when compared with morphine PCA combined with localized intra-arterial lidocaine injection [19].…”

Section: Discussionmentioning

confidence: 99%

“…Morphine PCA has been evaluated in a number of randomized double-blind studies. Addition of ketamine to morphine PCA did not reduce morphine requirement in one study [14], while comparison to remifentanil target controlled infusion showed significant reduction of early Pain Intensity (PI) in the remifentanil group [15]. Morphine PCA has also been compared to fentanyl PCA in a nonrandomized study, where it was found to produce lower PI scores [16].…”

Section: Introductionmentioning

confidence: 99%

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A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Konstantatos

Kavnoudias

Stegeman

et al. 2014

Cardiovasc Intervent Radiol

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Purpose To evaluate the analgesic efficacy of oral premedication of oxycodone in a group of patients undergoing elective uterine artery embolization under sedation for fibroid disease. Methods Thirty-nine patients (mean age 42.3 years) were prospectively randomized 1:1 to receive 20 mg oxycodone or placebo orally immediately before their procedure. At the commencement of the procedure, patients were provided with a patient-controlled analgesia device for 24 h, programmed to deliver 1 mg boluses of intravenous morphine with a 5 min lockout. Mean visual analog scale pain intensity ratings (0-100 mm) were measured from both groups and evaluated over 0 to 6 h as the primary end point. Other measured parameters included opioid-related side effects and eligibility for discharge (NCT00163930; September 12, 2005). Results Early pain intensity did not vary significantly between the active and placebo groups [mean (standard deviation): 3.2 (2.5) vs. 3.1 (2.2), p = 0.89]. The oxycodone group, however, experienced significantly more nausea (p = 0.035) and a greater incidence of vomiting (p = 0.044). Overall opioid requirement over 24 h, measured as oral morphine equivalent, was greater in the oxycodone group (median [interquartile range]: 64.5

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Konstantatos

Kavnoudias

Stegeman

et al. 2014

Cardiovasc Intervent Radiol

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“…PCA without background infusion is also used. Post-operative PCA usage has been described for analgesics such as morphine, piritramide, fantanyl, tramadol, and others [47][48][49][50][51]. In a systematic review, Walder and colleagues showed that the some evidence exists that in the postoperative pain setting, PCA with opioids, compared with conventional opioid treatment, improves analgesia and decreases the risk of pulmonary complications, and that patients prefer this option [52].…”

Section: Examples Of Closed-loop Drug Administrationmentioning

confidence: 99%

Automated Drug Delivery in Anesthesia

Neckebroek

Smet²,

Struys

2012

Curr Anesthesiol Rep

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Automated drug administration by closed-loop systems has been proposed to optimize drug administration during anesthesia and sedation. Closed-loop systems are able to make decision on their own and try to reach and maintain a preset target. This review describes the milestones and recent development in automated drug delivery systems applicable during sedation, anesthesia and postoperative pain relief.

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“…At the time this study was initiated, the standard of care to treat pain following UFE included the administration of oral or intravenous (IV) opioids and non-steroidal anti-inflammatory drugs (NSAID). Several options for post-procedural pain control have been suggested, many of which use opioid-based IV patient-controlled analgesia (PCA) with oral NSAIDs [9,10]. However, opioid-based therapy may result in dose-dependent side effects such as nausea, drowsiness, itching, sedation and respiratory depression [11].…”

Section: Introductionmentioning

confidence: 99%

Reducing Post Procedural Pain and Opioid Consumption Using IV Acetaminophen and IV Ibuprofen Following Uterine Fibroid Embolization: A Prospective, Doubleblind, Randomized Controlled Study

Hoffman¹,

Jahr²,

Yarosh³

et al. 2018

J Imaging Interv Radiol

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Purpose: Uterine fibroid embolization (UFE) is associated with post-procedural pain and nausea. In this double-blind randomized controlled study, we compared pre-procedure intravenous (IV) acetaminophen/ibuprofen to postprocedure IV ketorolac in UFE patients. Methods:After institutional review board approval, UFE candidates 21-60 years old were screened and randomly assigned to one of four arms: acetaminophen (1 g), ibuprofen (800 mg), acetaminophen (1 g) and ibuprofen (800 mg) combined, and an active comparator, ketorolac (30 mg). All received rescue patient-controlled hydromorphone for 24 h post-procedure. Primary outcome was measurement of pain intensity (visual analog scale: VAS) between the acetaminophen/ibuprofen group and the ketorolac group. The secondary outcomes were opioid and anti-emetic requirements and nausea intensity (VAS).Results: 40 subjects were analysed: acetaminophen/ ibuprofen (N=16); acetaminophen (N=4); ibuprofen (N=4); ketorolac (N=16). The maximum and mean VAS scores for pain were not different between the acetaminophen/ ibuprofen group and the ketorolac group without adjusting for opioid consumption (p=0. 243 and p=0.208, respectively). Total opioid consumption in morphine equivalents (mean [±SE]) was 28.09 mg (±4.58) in the acetaminophen/ibuprofen group and 40.33 mg (±7.79) in the ketorolac group (p=0.087), demonstrating a trend favouring the acetaminophen/ibuprofen group. The mean and maximum nausea scores showed a trend and significant difference (p=0.095 and p=0.003), respectively, favouring the ketorolac group. Conclusion:IV acetaminophen/ibuprofen demonstrated comparable pain control, although there was less opioid requirement for the acetaminophen/ibuprofen group compared to the ketorolac group. Maximum nausea scores were significantly increased with similar ondansetron requirements. Therefore, antiemetic prophylaxis is needed regardless of group.

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Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization

Abstract: Remifentanil PCA-TCI with a slow and progressive adapted algorithm without any associated premedication or co-medication is feasible in young healthy women undergoing UAE.

Cited by 15 publications

References 24 publications

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Automated Drug Delivery in Anesthesia

Reducing Post Procedural Pain and Opioid Consumption Using IV Acetaminophen and IV Ibuprofen Following Uterine Fibroid Embolization: A Prospective, Doubleblind, Randomized Controlled Study

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