Patient-controlled analgesia case study

In a prospective randomized, double-blind, placebo-controlled study in 100 patients scheduled for elective orthopedic surgery and presenting with pruritus induced by epidural or intrathecal morphine, intravenous ondansetron 8 mg was effective in 70% of cases and placebo in 30% (23). Ondansetron was well tolerated, did not change the degree of analgesia, and was not associated with adverse effects usually associated with ondansetron, such as headache, abdominal pain, and cardiac dysrhythmias. 

Oxycodone has been available in oral form for at least 70 years and is rarely given by other routes. In a study of subcutaneous oxycodone hydrochloride 100 mg/ml for opioid rotation in 63 patients with cancer pain (maximum dose 4.5-660 mg in 24 hours for 1-49 days) there was local toxicity in only two cases, and this included central pallor of the skin at the needle site with surrounding erythema and bruising there was no necrosis (10). The design of the study made it difficult to compare the adverse effects profile of subcutaneous oxycodone with oral oxycodone or other opioids. Randomized controlled trials are needed to support the conclusions that subcutaneous oxycodone is free from adverse effects and is a better vehicle for analgesia in terminal cancer. 

Yukawa Y, Kato F, Ito K, Nakashima H, MacHino M, Hirano K, Tauchi R. A case-control study of preemptive analgesia for postoperative pain in patients undergoing posterior lumbar interbody fusion continuous subcutaneous morphine alone and combined with intrathecal injection. J Spinal Disord Tech 2010 23 333-7. 

Gastrointestinal In a retrospective case-control study of 75 patients undergoing laparoscopic colorectal resection with primary anastomosis, there was a higher rate of anastomotic leakages in patients who took oral diclofenac for postoperative analgesia (seven of 33 patients) compared with patients who received opioid analgesia (one of 42 patients) [36 ]. 

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