Study Patient-Controlled Analgesia

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... 

Chen JY, Wu GJ, Mok MS, et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients—a prospective, randomized, double-blind study. Acta Anaesthesiol Scand. 2005 49 546-551. 

Maxwell LG, Kaufmann SC, Bitzer S, et al. The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia a double-blind, prospective, randomized, controlled study. Anesth Analg. 2005 100 953-958. 

In a randomized, placebo-controlled, double-blind study of the relative efficacies of patient-controlled analgesia (PCA) regimens (63), 60 patients undergoing elective total hip or knee replacement were randomly allocated to receive epidural diamorphine 2.5 mg followed by a PCA bolus 1 mg with a 20-minute lockout (group 1), subcutaneous diamorphine 2.5 mg followed by a PCA bolus 1 mg with a 10-minute lockout (group 2), or epidural diamorphine 2.5 mg in 4 ml of 0.125% bupivacaine followed by a PCA bolus of 1 mg diamorphine in 4 ml... 

Patient-controlled analgesia with epidural pethidine or a single bolus of epidural morphine 4 mg during the 24 hours after cesarean section has been studied in 78 women (91). There were no differences in the degree of analgesia or opioid adverse effects profiles. 

Zimmermann AR, Kibblewhite D, Sleigh J. Comparison of morphine/droperidol and tramadoFdroperidol mixture for patient controlled analgesia (PCA) after cardiac surgery a prospective, randomised, double-blind study. J Acute Pain 2002 4 65-9. 

In 1994, Smythe and colleagues published a study evaluating pharmacy and nursing time requirements, quality of pain control, and cost of patient-controlled analgesia (PCA) versus intramuscular (IM) analgesic therapy. This study showed the PCA therapy provided better pain control than IM therapy after gynecological... 

Grond, S. Meuser, T. Zech, D. Hennig, U. Lehmann, K.A. Analgesic efficacy and safety of tramadol enantiomers in comparison with the racemate a randomised, double-blind study with gynaecological patients using intravenous patient-controlled analgesia. Pain 1995, 62, 313-320. 

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. ... 

Ketamine-I-morphine has been compared with morphine in intravenous patient-controlled analgesia [132 ]. In seven studies there were higher frequencies of adverse reactions (including nausea, pruritus, sleepiness, desaturation, and urinary retention) when morphine was used alone four studies did not report any difference. 

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... 

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. 

J. U. Cope, A. E. Morrison and J. Samuels-Reid, Adolescent use of insulin and patient-controlled analgesia pump technology a 10-year Food and Drug Administration retrospective study of adverse events. Pediatrics, 2008, 121, el 33-el 38. 

Low-dose intrathecal morphine (0.3 mg) plus 0.5% spinal bupivacaine and patient-controlled intravenous morphine (given as a 1 mg bolus with a 5-minute lockout period) has been compared with patient-controlled intravenous morphine alone in 38 patients undergoing knee surgery in a randomized, double-blind study (40). The former combination provided effective analgesia with a low and non-significant incidence of emesis, pruritus, and respiratory depression. 

In a randomized, double-blind study in 120 patients undergoing major abdominal surgery the combination of sufentanil 0.75 micrograms/ml with ropivacaine 0.2% provided optimal postoperative patient-controlled epidural analgesia with the fewest adverse effects of the regimens used (ropivacaine alone, ropivacaine and sufentanil 0.5, 0.75, or 1.00microgram/ml) (15). 

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. 

The use of cervical epidural administration of fentanyl is questionable. In a study of patient-control-led cervical epidural fentanyl infusion, compared with patient-controlled IV fentanyl infusion for pain relief after pharyngolarynx surgery, results show that cervical epidural fentanyl analgesia provides marginally better pain relief at rest with no decrease in fentanyl consumption. Also, administration of fentanyl in the cervical epidural space is questionable because of the possible complications of the technique. 

Wong C. Neostigmine decreases bupivacaine use by patient-controlled epidural analgesia during labor a randomized controlled study. Anesth Analg 2009 109(2) 524-530. 

---