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Hong Kong Medical Journal = Xianggang... Oct 2020Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We... (Review)
Review
Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We review the most recent evidence on the efficacy and safety of these techniques. Over the past decade, the availability of safer local anaesthetics, ultra-short acting opioids, combined spinal-epidural needles, patient-controlled analgesic devices, and ultrasound have revolutionised obstetric regional analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique, as it leads to higher maternal satisfaction and good maternal and fetal safety profiles. We examine the controversies and myths concerning the initiation, maintenance, and discontinuation of epidural analgesia. Recent evidence will also be reviewed to address concerns about the effects of epidural analgesia on the rates of instrumental and operative delivery, lower back pain, and breastfeeding. New developments in labour analgesia are also discussed.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Female; Humans; Labor Pain; Pain Management; Pregnancy
PubMed: 32943586
DOI: 10.12809/hkmj208632 -
Minerva Anestesiologica Aug 2016
Topics: Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Humans; Pain, Postoperative
PubMed: 26883748
DOI: No ID Found -
Anaesthesia May 1997
Topics: Analgesia, Patient-Controlled; Humans; Nurse-Patient Relations; Pain, Postoperative; Patient Satisfaction
PubMed: 9165955
DOI: 10.1111/j.1365-2044.1997.126-az0120.x -
Journal of Clinical Anesthesia 1993
Topics: Analgesia; Analgesia, Patient-Controlled; Clinical Trials as Topic; Humans; Injections, Intramuscular; Meta-Analysis as Topic; Research Design; Statistics as Topic
PubMed: 8318236
DOI: 10.1016/0952-8180(93)90012-4 -
Anaesthesia Aug 2017
Topics: Acute Pain; Analgesia, Patient-Controlled; Cost-Benefit Analysis; Emergency Service, Hospital; Humans
PubMed: 28555748
DOI: 10.1111/anae.13893 -
Wounds : a Compendium of Clinical... Jan 2019Patient-controlled analgesia (PCA) has become a common practice after surgery, but research has shown that the use of PCA is also a significant risk factor for pressure... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patient-controlled analgesia (PCA) has become a common practice after surgery, but research has shown that the use of PCA is also a significant risk factor for pressure ulcers. However, no meta-analysis or conclusive review has investigated whether patients using PCA have a significantly higher prevalence of pressure ulcers.
OBJECTIVE
This study explores the association between the use of postoperative PCA and the prevalence of pressure ulcers.
MATERIALS AND METHODS
PubMed, the Cochrane Controlled Register of Trials, Web of Science, China National Knowledge Infrastructure, Wanfang, and Vip databases were searched to identify studies, published up until November 2016, concerning the association between PCA and pressure ulcer prevalence. A manual search of the references of relevant studies also was performed. Odds ratio (OR) and corresponding 95% confidence interval (CI) were used to evaluate the strength of association between the use of PCA after surgery and pressure ulcer prevalence. The methodological quality of included case-control studies and cohort studies was assessed by the Newcastle-Ottawa Scale. The test of heterogeneity, subgroup analysis, meta-regression, Begg's funnel plot, and Egger's test also were used.
RESULTS
Four cohort studies and 1 case-control study were included. In these 5 studies, 265 participants were identified. In pooled analysis, heterogeneity was 0 among the studies. In a fixed effects model, postoperative pressure ulcer was associated with PCA (pooled OR, 3.525; 95% CI, 1.655-7.509). Subgroup analysis of these 5 studies yielded an OR of 3.29 (95% CI, 1.47-7.40) for cesarean section, 5.10 (95% CI, 0.24-107.55) for general surgery, and 5.10 (95% CI, 0.24-107.55) for orthopedic surgery. There was no heterogeneity among the 5 studies. Additional meta-regression of year and incidence did not find significant outcomes.
CONCLUSIONS
This meta-analysis shows PCA may be associated with an increased risk of postoperative pressure ulcer, especially after caesarean section. More evidence-based studies on this research field are needed to draw a firmer conclusion.
Topics: Analgesia, Obstetrical; Analgesia, Patient-Controlled; Cesarean Section; Female; Humans; Observational Studies as Topic; Pain Measurement; Postoperative Complications; Pregnancy; Pressure Ulcer
PubMed: 30372416
DOI: No ID Found -
The Journal of Surgical Research Jul 2022The initial settings on an intravenous patient-controlled analgesia (IV-PCA) pump can represent a significant source of postoperative opioid exposure. The primary aim of...
INTRODUCTION
The initial settings on an intravenous patient-controlled analgesia (IV-PCA) pump can represent a significant source of postoperative opioid exposure. The primary aim of this study was to evaluate the impact of first day IV-PCA use on total inpatient opioid use after open pancreatectomy, before and after standardization of initial dosing.
METHODS
Inpatient oral morphine equivalents (OMEs) were reviewed for pancreatectomy patients treated with IV-PCA at a single institution before and after (3/2016-8/2017 versus 3/2019-11/2020) implementation of a standardized initial IV-PCA dosing regimen (initial limit 0.1 mg hydromorphone, or 1 mg OME, every 10 min as needed). IV-PCA OME in the first 24 h and the total inpatient OME were compared between cohorts.
RESULTS
Of 220 total patients, 132 were in the prestandardization (PRE) historical cohort. A first-24-h IV-PCA use was different (PRE median 95 mg versus poststandardization [POST] 15 mg, P < 0.001). The median total inpatient OME was different (P < 0.001) between PRE (525 mg, interquartile range [IQR] 239-951 mg) and POST patients (129 mg, IQR 65-204 mg) with 77% (median 373 mg) of total inpatient OMEs contributed by IV-PCA in the PRE and 56% (median 64 mg) in the POST cohorts. There were similar patient-reported pain scores between groups.
CONCLUSIONS
Standardizing initial IV-PCA settings was associated with a reduced first-24-h opioid exposure, proportional and absolute total IV-PCA use, and total inpatient OMEs. Because of the contribution of an IV-PCA to the total inpatient opioid exposure, purposeful reduction or omission of an IV-PCA is critical to perioperative opioid reduction strategies.
Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Humans; Inpatients; Morphine; Opioid-Related Disorders; Pain, Postoperative; Pancreatectomy
PubMed: 35306260
DOI: 10.1016/j.jss.2022.02.031 -
BMC Anesthesiology Jan 2021To investigate the relationship between intrapartum maternal fever and the duration and dosage of patient-controlled epidural analgesia (PCEA). (Observational Study)
Observational Study
BACKGROUND
To investigate the relationship between intrapartum maternal fever and the duration and dosage of patient-controlled epidural analgesia (PCEA).
METHODS
This observational study included 159 pregnant women who voluntarily accepted PCEA. During labor, patients with body temperature ≥ 38 °C were classified into the Fever group, (n = 42), and those with body temperature < 38 °C were classified into the No-fever group (n = 117). The outcome measures included the duration of PCEA, number of PCEA, and total PCEA amount. Body temperature and parturient variables, including interpartum fever status and the duration of any fever were monitored.
RESULTS
The total PCEA duration and total PCEA amount in the Fever group were significantly higher than the corresponding values in the No-fever group (both, p < 0.05). The duration of fever was weakly correlated with the duration of PCEA (R = 0.08) and the total PCEA amount (R = 0.05) (both, p < 0.05). The total and effective PCEA were higher in the Fever group than in the No-fever group (both, p < 0.05). The total PCEA duration and total PCEA amount were positively correlated with the incidence of fever (both, p < 0.05). The diagnostic cutoff value for fever was 383 min, with a sensitivity of 78.6% and specificity of 57.3%. The mean temperature-time curves showed that parturients who developed fever had a steeper rise in temperature.
CONCLUSIONS
This study showed that there were weak time- and dose-dependent correlations between PCEA and maternal fever during delivery. A total PCEA duration exceeding 6.3 h was associated with an increase in the duration of maternal intrapartum fever.
Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fever; Humans; Labor, Obstetric; Pregnancy; Time Factors
PubMed: 33514322
DOI: 10.1186/s12871-021-01249-1 -
Journal of Pediatric Surgery May 2014The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/PURPOSE
The minimally invasive pectus excavatum repair (MIPER) is a painful procedure. The ideal approach to postoperative analgesia is debated. We performed a systematic review and meta-analysis to assess the efficacy and safety of epidural analgesia compared to intravenous Patient Controlled Analgesia (PCA) following MIPER.
METHODS
We searched MEDLINE (1946-2012) and the Cochrane Library (inception-2012) for randomized controlled trials (RCT) and cohort studies comparing epidural analgesia to PCA for postoperative pain management in children following MIPER. We calculated weighted mean differences (WMD) for numeric pain scores and summarized secondary outcomes qualitatively.
RESULTS
Of 699 studies, 3 RCTs and 3 retrospective cohorts met inclusion criteria. Compared to PCA, mean pain scores were modestly lower with epidural immediately (WMD -1.04, 95% CI -2.11 to 0.03, p=0.06), 12 hours (WMD -1.12; 95% CI -1.61 to -0.62, p<0.001), 24 hours (WMD -0.51, 95%CI -1.05 to 0.02, p=0.06), and 48 hours (WMD -0.85, 95% CI -1.62 to -0.07, p=0.03) after surgery. We found no statistically significant differences between secondary outcomes.
CONCLUSIONS
Epidural analgesia may provide superior pain control but was comparable with PCA for secondary outcomes. Better designed studies are needed. Currently the analgesic technique should be based on patient preference and institutional resources.
Topics: Analgesia, Epidural; Analgesia, Patient-Controlled; Child; Cost-Benefit Analysis; Funnel Chest; Humans; Length of Stay; Minimally Invasive Surgical Procedures; Operative Time; Pain, Postoperative; Research Design; Retrospective Studies
PubMed: 24851774
DOI: 10.1016/j.jpedsurg.2014.02.072 -
JSLS : Journal of the Society of... 2014Limited data are available comparing epidural and patient-controlled analgesia in site-specific colorectal surgery. The aim of this study was to evaluate 2 modes of...
BACKGROUND AND OBJECTIVES
Limited data are available comparing epidural and patient-controlled analgesia in site-specific colorectal surgery. The aim of this study was to evaluate 2 modes of analgesia in patients undergoing laparoscopic right colectomy (RC) and low anterior resection (LAR).
METHODS
Prospectively collected data on 433 patients undergoing laparoscopic or laparoscopic-assisted colon surgery at a single institution were retrospectively reviewed from March 2004 to February 2009. Patients were divided into groups undergoing RC (n = 175) and LAR (n = 258). These groups were evaluated by use of analgesia: epidural analgesia, "patient-controlled analgesia" alone, and a combination of both. Demographic and perioperative outcomes were compared.
RESULTS
Epidural analgesia was associated with a faster return of bowel function, by 1 day (P < .001), in patients who underwent LAR but not in the RC group. Delayed return of bowel function was associated with increased operative time in the LAR group (P = .05), patients with diabetes who underwent RC (P = .037), and patients after RC with combined analgesia (P = .011). Mean visual analogue scale pain scores were significantly lower with epidural analgesia compared with patient-controlled analgesia in both LAR and RC groups (P < .001).
CONCLUSION
Epidural analgesia was associated with a faster return of bowel function in the laparoscopic LAR group but not the RC group. Epidural analgesia was superior to patient-controlled analgesia in controlling postoperative pain but was inadequate in 28% of patients and needed the addition of patient-controlled analgesia.
Topics: Analgesia, Epidural; Analgesia, Patient-Controlled; Colorectal Surgery; Female; Humans; Laparoscopy; Male; Middle Aged; Pain, Postoperative
PubMed: 25419110
DOI: 10.4293/JSLS.2014.00207