Patient-controlled analgesia postoperative

A study on racial differences in receipt of analgesics found that nearly three-fourths (74%) of white patients compared with 57% of African American patients received analgesics for lower extremity fractures in emergency departments (Todd et al., 2001). An assessment of racial/ethnic differences in physicians prescriptions of patient-controlled analgesia for postoperative pain found that after adjustment for age, gender, preoperative... 

Dosages and routes of administration Morphine is available in different salt forms but the hydrochloride and sulfate (Vermeire and Remon, 1999) are used preferentially. The compound can be administered by the oral, parenteral or intraspinal route. Oral application is preferred for chronic pain treatment and various slow release forms have been developed to reduce the administration frequency to 2-3 times per day (Bourke et al., 2000). Parenteral morphine is used in intravenous or intramuscular doses of 10 mg, mostly for postoperative pain and self-administration devices are available for patient-controlled analgesia (PCA). Morphine is additionally used for intraspinal (epidural or intrathecal) administration. Morphine is absorbed reasonably well in the lower gastrointestinal tract and can be given as suppositories. 

Lehmann, K.A., Tenbuhs, B., Hoeckle, W. Patient-controlled analgesia with piritramid for the treatment of postoperative pain, Acta Anaesthesiol. Belg. 1986, 37, 247-257. 

Aygun S, Kocoglu H, Goksu S, et al. Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine + fentanyl combination. EurJ Gynaecol Oncol. 2004 25 498-501. 

Ballantyne JC, Carr DB, Chalmers TC, et al. Postoperative patient-controlled analgesia meta-analyses of initial randomized control trials. J Clin Anesth. 1993 5 182-193. 

Sveticic G, Eichenberger U, Curatolo M. Safety of mixture of morphine with ketamine for postoperative patient-controlled analgesia an audit with 1026 patients. Acta Anaesthesiol Scand. 2005 49 870-875. 

Sinatra, R. (2005), The fentanyl FI Cl patient-controlled transdermal system (PCTS) An alternative to intravenous patient-controlled analgesia in the postoperative setting, Clin. Pharmacokinet., 44(Suppl 1), 1-6. 

Droperidol 0.5 micrograms reduced the need for postoperative morphine delivered via a patient-controlled analgesia device (31). At these doses it was non-sedating and caused no dyskinetic movements. 

G. W.A. Kenny, G.N.C. McArdle, C.S. The influence of patient characteristics on the requirements for postoperative analgesia. A reassessment using patient-controlled analgesia. Anaesthesia 1989, 44 (1), 2-6. 

SUvasti M, Pitkanen M. Continnous epidural analgesia with bupivacaine-fentanyl versus patient-controlled analgesia with i.v. morphine for postoperative pain relief after knee ligament surgery. Acta Anaesthesiol Scand 2000 44(1) 37 2. 

Camu F, Van Aken H, Bovill JG. Postoperative analgesic effects of three demand-dose sizes of fentanyl administered by patient-controlled analgesia. Anesth Analg 1998 87(4) 890-5. 

Millo J, Siddons M, Innes R, Laurie PS. Randomised double-blind comparison of ondansetron and droperidol to prevent postoperative nausea and vomiting associated with patient-controlled analgesia. Anaesthesia 2001 56(l) 60-5. 

Motamed C, Spencer A, Farhat F, Bourgain JL, Lasser P, Jayr C. Postoperative hypoxaemia continuous extradural infusion of bupivacaine and morphine vs patient-controlled analgesia with intravenous morphine. Br J Anaesth 1998 80(6) 742-7. 

Dinsdale JE, Rollnik JD, Shapiro H. 1995. The effect of ethnicity on prescriptions for patient-controlled analgesia for postoperative pain . Pain 66(1) 9-12. 

The client is postoperative for a cervical laminectomy and is prescribed meperidine (Demerol), a narcotic analgesic, by patient-controlled analgesia (PGA) pump. Which instruction regarding pain control should the nurse teach the client ... 

Patients who were given a single 4-mg dose of ondansetron one minute before induction of anaesthesia required 26 to 35% more tramadol by patient controlled analgesia (PCA) from 1 to 4 hours postoperatively than those who received placebo. Similarly, a 1-mg/hour ondansetron infusion increased the dose of postoperative tramadol used during PCA by two- to threefold in 30 patients, when compared with 29 patients who received placebo. Moreover, in this study the group receiving ondansetron actually experienced more vomiting, probably because they used more tramadol, which caused an emetic effect not well controlled by the ondansetron. ... 

In a double-blind, placebo-controlled study in 72 patients undergoing laparoscopic cholecystectomy, oral etoricoxib 120 mg given 1.5 hours before surgery reduced the need for postoperative patient controlled analgesia (PCA) with fentanyl, but opioid-related adverse effects were not reduced. Furthermore, the safety of short-term perioperative use of coxibs has been questioned, as some studies have reported more adverse effects (including myocardial infarction, cardiac arrest, stroke, and pulmonary embolism) with parecoxib or valdecoxib compared with placebo. ... 

A patient who underwent renal transplantation was given ciclosporin 6 mg/kg daily by intravenous infusion over 2 hours and intravenous meth-ylprednisolone postoperatively. He also received patient-controlled analgesia (PCA) as bolus doses of morphine 0.5 mg to a total dose of 13 mg on the first day and 11 mg on the second day. On the third day he developed insomnia, anxiety, amnesia, aphasia and severe confusion. The morphine was discontinued and the symptoms subsided after treatment with propofol, diazepam and haloperidol. It was suggested that ciclosporin may have decreased the excitation threshold of neuronal cells, which potentiated the dysphoric effects of morphine. ... 

Comparative studies Butorphanol 4 micro-grams/kg/hour as intravenous patient-controlled analgesia was as effective and safe as fentanyl 0.4 micrograms/kg/hour in the relief of moderate postoperative pain... 

Carstensen M, Moller AM. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain a qualitative review of randomized trials. Br J Anaesth 2010 104(4) 401-6. 

Thakore B, D Mello J, Saksena S, Butani M. Comparison of fentanyl and butorphanol for postoperative pain relief with intravenous patient controlled analgesia. Acute Pain 2009 11 93-9. 

Viscusi ER, Siccardi M, Damaraju CV, Hewitt DJ, Kershaw R The safety and efficacy of fentanyl iontophoretictransdermal system compared with morphine intravenous patient-controlled analgesia for postoperative pain management an analysis of pooled data from three randomized, active-controlled clinical trials. Anesth A al 2007 105(5) 1428-1436. 

Epidural morphine 4 mg has been compared with epidural morphine 5 mg as patient-controlled analgesia for postoperative analgesia in women after cesarean section the latter had more nausea and vomiting (16% versus 72%) and more pruritus (29% versus 82%) [103 ]. 

Ondansetron In a randomized, double-blind study in 150 patients undergoing abdominal surgery with patient-controlled analgesia using morphine 1.5 mg, the combination of ondansetron 30 mg and prochlorperazine 20 mg reduced postoperative nausea and vomiting in the first 24 hours after surgery but not during the next 24 hours [130 J. 

When butorphanol 4 micrograms/kg/hour was compared with fentanyl 0.4 micrograms/ kg/hour as intravenous patient-controlled analgesia for postoperative pain after abdominal hysterectomy in 100 patients, there were few adverse reactions [197 ]. Respiratory rate was reduced by butorphanol 1 hour after the start of treatment. 

Kim SY, Kim EM, Nam K-H, Chang DJ, Nam SH, Kim KJ. Postoperative intravenous patient-controlled analgesia in thyroid surgery comparison of fentanyl and ondansetron regimens with and without the nonsteroidal anti-inflammatory drug ketorolac. Thyroid 2008 18(12) 1285-90. 

Yeh Y-C, Lin T-F, Lin F-S, Wang Y-P, Lin C-J, Sun W-Z. Combination of opioid agonist and agonist-antagonist patient-controlled analgesia requirement and adverse events among different-ratio morphine and nalbuphine admixtures for postoperative pain. Br J Anaesth 2008 101(4) 542-8. 

Ho HS. Patient-controlled analgesia versus oral controlled-release oxycodone— are they interchangeable for acute postoperative pain after laparoscopic colorectal surgeries Oncology 2008 74(Suppl 1) 61-5. 

Patient-controlled analgesia (PCA) is a computer-based medical technology now used extensively to treat postoperative pain via the self-administration of analgesic agents such as morphine. Potential... 

ChellyJE, Grass J, Houseman TW, et al. The safety and efficacy of a fentanyl patient-controlled transder-mal system for acute postoperative analgesia a multicenter, placebo-controlled trial. Anesth Analg. 2004 98 427-433. 

Antok E, Bordet F, Duflo F, et al. Patient-controlled epidural analgesia versus continuous epidural infusion with ropivacaine for postoperative analgesia in children. Anesth Analg. 2003 97 1608-1611. 

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