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HPB : the Official Journal of the... Aug 2022This randomized clinical trial was performed to compare pain scales between intravenous patient-controlled analgesia (IV-PCA) and patient-controlled epidural analgesia... (Randomized Controlled Trial)
Randomized Controlled Trial
Randomized controlled study comparing the analgesic effects of intravenous patient-controlled analgesia and patient-controlled epidural analgesia after open major surgery for pancreatobiliary cancer.
BACKGROUND
This randomized clinical trial was performed to compare pain scales between intravenous patient-controlled analgesia (IV-PCA) and patient-controlled epidural analgesia (PCEA) in patients undergoing open surgical resection of major pancreatobiliary malignancies.
METHODS
One hundred ten patients were randomly assigned to the PCEA or IV-PCA group. We compared the numeric rating scale pain score during ambulation on postoperative day (PD) 2 and at rest (at 06:00, 12:00, and 18:00) from PD 1 to 7, the serum level of troponin I on PD 1, and the incidence of postoperative complications between the two groups.
RESULTS
There were no significant differences in the pain scores during ambulation on PD 2, at rest up to PD 7, serum troponin I level, and postoperative complication rates. The incidences of nausea (20.4% vs. 6.3%; p = 0.039) and drowsiness (20.4% vs. 0%; p = 0.001) were higher in the IV-PCA group and the rate of dysuria (0% vs. 14.6%; p = 0.004) was higher in the PCEA group.
CONCLUSION
PCEA showed no superiority over IV-PCA in terms of postoperative pain relief or morbidity after major open surgery for pancreatobiliary malignancies. The method of analgesia should be considered based the characteristics of the patient, surgeon, anesthesiologist, and institute.
Topics: Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Humans; Neoplasms; Pain, Postoperative; Troponin I
PubMed: 35183448
DOI: 10.1016/j.hpb.2022.01.013 -
Journal of Orthopaedic Surgery and... Aug 2022Insufficient pain control after lower limb arthroplasty results in delayed recovery and increased risk for pain chronicization. The ideal kind of analgesia is still...
Pain levels and patient comfort after lower limb arthroplasty comparing i.v. patient-controlled analgesia, continuous peripheral nerve block and neuraxial analgesia: a retrospective cohort analysis of clinical routine data.
BACKGROUND
Insufficient pain control after lower limb arthroplasty results in delayed recovery and increased risk for pain chronicization. The ideal kind of analgesia is still discussed controversially. We conducted a retrospective analysis of single-center routine data from a German university hospital, including patients receiving either total hip (THA) or knee arthroplasty (TKA).
METHODS
All patients received general anesthesia. Patients undergoing THA received either continuous epidural ropivacaine infusion (0.133%, Epi) or patient-controlled analgesia (PCA) with the Wurzburg Pain Drip (tramadol, metamizole and droperidol, WPD) or with piritramide (Pir). After TKA, patients received either continuous femoral nerve block (ropivacaine 0.2%, PNB) or Pir.
RESULTS
The analyzed cohort comprised 769 cases. Use of WPD after THA (n = 333) resulted in significantly reduced Numeric Rating Scale (NRS) values at rest, compared to Epi (n = 48) and Pir (n = 72) (.75 [IQR 1.14] vs. 1.17 [1.5], p = .02 vs. 1.47 [1.33], p < .0001) as well as maximum NRS scores (2.4 [1.7] vs. 3.29 [1.94], p < .001 vs. 3.32 [1.76], p < .0001). Positive feedback during follow-up visits was significantly increased in patients with a WPD PCA (p < .0001), while negative feedback (senso-motoric weakness/technical problems/nausea/dizziness/constipation) was particularly increased in Epi patients and lowest in those with WPD (p < .0001). After TKA, Pir (n = 131) resulted in significantly reduced NRS values at rest, compared to PNB (n = 185) (1.4 [1.4] vs. 1.6 [1.68], p = .02). Positive feedback was increased in patients with a Pir PCA in comparison with PNB (p = .04), while negative feedback was increased in PNB patients (p = .04). Overall, WPD presented with the lowest rate of any complications (8.7%), followed by Pir (20.2%), PNB (27.6%) and Epi (31.3%) (p < .001).
CONCLUSIONS
In the assessed population, the use of a WPD PCA after THA offered better pain control and patient comfort in comparison with continuous epidural or piritramide-based analgesia. After TKA, the use of a Pir PCA provided superior analgesia and a lower complication rate compared to continuous PNB.
Topics: Analgesia, Patient-Controlled; Anesthetics, Local; Arthroplasty, Replacement, Knee; Femoral Nerve; Humans; Lower Extremity; Nerve Block; Pain, Postoperative; Patient Comfort; Peripheral Nerves; Pirinitramide; Retrospective Studies; Ropivacaine
PubMed: 35962409
DOI: 10.1186/s13018-022-03277-0 -
Anaesthesia Mar 1997
Topics: Aged; Analgesia, Patient-Controlled; Brachial Plexus; Female; Humans; Joint Prosthesis; Nerve Block; Pain, Postoperative; Shoulder Joint
PubMed: 9124668
DOI: 10.1111/j.1365-2044.1997.097-az0087.x -
Chang Gung Medical Journal 2006In recent years, patient-controlled epidural analgesia (PCEA) has been developed as an attractive alternative to continuous epidural infusion (CEI) for labor pain... (Comparative Study)
Comparative Study
BACKGROUND
In recent years, patient-controlled epidural analgesia (PCEA) has been developed as an attractive alternative to continuous epidural infusion (CEI) for labor pain control. PCEA is still not popular for labor pain control in Taiwan and disparities may exist between different ethnic and cultural groups toward the attitude of labor pain control. The aim of this study was to investigate whether there were any differences between PCEA and CEI in the maintenance of epidural analgesia for Taiwanese parturients undergoing spontaneous delivery.
METHODS
We collected data of 179 parturient requests for epidural labor analgesia. They were allocated into two groups with PCEA (n = 81) or CEI (n = 98) for maintenance with the same solution of 0.08% ropivacaine and 2 microg/mL fentanyl mixture. The demographic characteristics, epidural maintenance methods, dosage requirements, obstetrical outcomes, intervention of inadequate analgesia or side effects, and the quality of labor analgesia of parturient were also analyzed.
RESULTS
There were no differences in demographic characteristics, duration of 1st and 2nd stages, delivery methods, fetal Apgar scores, local anesthetics usage, and analgesic qualities between the PCEA and CEI groups. There were also more requirements for intervention by the anesthesiologist due to inadequate analgesia in the CEI group.
CONCLUSION
The results of this study provided further evidence that PCEA is a highly effective method of the control of labor pain, which was highly accepted by women in labor. In a busy obstetric unit, this could potentially improve parturient satisfaction and reduce the workloads of clinicians and nurses.
Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Female; Humans; Pregnancy; Retrospective Studies
PubMed: 17302221
DOI: No ID Found -
BMJ Open Nov 2022When patients receive patient-controlled intravenous analgesia (PCIA), no basal infusion is always recommended, as the addition of a basal infusion increases the...
Effects of hydromorphone-based intravenous patient-controlled analgesia with and without a low basal infusion on postoperative hypoxaemia: study protocol for a randomised controlled clinical trial.
INTRODUCTION
When patients receive patient-controlled intravenous analgesia (PCIA), no basal infusion is always recommended, as the addition of a basal infusion increases the occurrence of postoperative opioid-induced respiratory depression. However, few studies have investigated whether low basal infusions increase the incidence of postoperative hypoxaemia relative to no basal infusion. We intend to conduct a clinical trial to test the hypothesis that PCIA with a low basal infusion does not increase the occurrence of postoperative hypoxaemia relative to PCIA with no basal infusion.
METHODS AND ANALYSIS
This single-centre parallel randomised controlled clinical trial will be conducted with 160 patients undergoing gastrointestinal tumour surgery. The assigned nurse will set analgesic pumps (low or no basal infusion PCIA) according to block-based randomisation sequence. Other investigators and all participants will be blinded to intervention allocation. All patients will be monitored continuously with the ep pod, a wireless wearable device, recording of oxygen saturation (SpO) and daily ambulation duration for 48 hours postoperatively. Three follow-up evaluations will be conducted to assess the analgesic effect (Numeric Rating Scale (NRS) pain score) and opioid-related side effects (Overall Benefit of Analgesic Score (OBAS)). The primary outcome will be the area under the curve for hypoxaemia (defined as SpO<95%) per hour. The secondary outcomes will be the areas under the curve for hypoxaemia defined as SpO<90% and <85% per hour, hydromorphone consumption, OBASs at 24 and 48 hours postoperatively, NRS scores at 4, 24 and 48 hours postoperatively, and the ambulation time per hour over 48 hours.
ETHICS AND DISSEMINATION
The study has been approved by the Xijing Hospital Ethics Committee (KY20212163-F-1). Written informed consent will be obtained from all patients or their authorised surrogates. All data will be managed with confidentiality. Findings will be disseminated at international conferences and in peer-reviewed journals.
TRIAL REGISTRATION NUMBER
ChiCTR2100054317.
Topics: Humans; Analgesia, Patient-Controlled; Hydromorphone; Analgesics, Opioid; Pain, Postoperative; Hypoxia; Randomized Controlled Trials as Topic
PubMed: 36385038
DOI: 10.1136/bmjopen-2022-064581 -
Medicina (Kaunas, Lithuania) Dec 2023Adequate pain management during early rehabilitation is mandatory for improving the outcomes of patients undergoing total knee arthroplasty (TKA). Conventional pain...
Adequate pain management during early rehabilitation is mandatory for improving the outcomes of patients undergoing total knee arthroplasty (TKA). Conventional pain management, mainly comprising opioids and epidural analgesia, may result in certain adverse effects such as dizziness, nausea, and motor blockade. We proposed a multimodal analgesic (MA) strategy involving the use of peripheral nerve block (NB), periarticular injection (PAI), and intravenous patient-controlled analgesia (IVPCA). This study compared the clinical efficacy and adverse effects of the proposed MA strategy and patient-controlled epidural analgesia (PCEA). We enrolled 118 patients who underwent TKA under spinal anesthesia. The patients followed either the MA protocol or received PCEA after surgery. The analgesic effect was examined using a numerical rating scale (NRS). The adverse effects experienced by the patients were recorded. A lower proportion of patients in the MA group experienced motor blockade (6.45% vs. 22.98%) compared to those in the PCEA group on the first postoperative day. Furthermore, a lower proportion of patients in the MA group experienced numbness (18.52% vs. 43.33%) than those in the PCEA group on the first postoperative day. The MA strategy can be recommended for reducing the occurrence of motor blockade and numbness in patients following TKA. Therefore, the MA strategy ensures early rehabilitation while maintaining adequate pain relief.
Topics: Humans; Pain Management; Analgesia, Patient-Controlled; Arthroplasty, Replacement, Knee; Analgesia, Epidural; Retrospective Studies; Pain, Postoperative; Hypesthesia; Treatment Outcome; Analgesics
PubMed: 38138240
DOI: 10.3390/medicina59122137 -
British Journal of Anaesthesia Jul 2021Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Thoracic epidural analgesia (TEA) has been suggested to improve survival after curative surgery for colorectal cancer compared with systemic opioid analgesia. The evidence, exclusively based on retrospective studies, is contradictory.
METHODS
In this prospective, multicentre study, patients scheduled for elective colorectal cancer surgery between June 2011 and May 2017 were randomised to TEA or patient-controlled i.v. analgesia (PCA) with morphine. The primary endpoint was disease-free survival at 5 yr after surgery. Secondary outcomes were postoperative pain, complications, length of stay (LOS) at the hospital, and first return to intended oncologic therapy (RIOT).
RESULTS
We enrolled 221 (110 TEA and 111 PCA) patients in the study, and 180 (89 TEA and 91 PCA) were included in the primary outcome. Disease-free survival at 5 yr was 76% in the TEA group and 69% in the PCA group; unadjusted hazard ratio (HR): 1.31 (95% confidence interval [CI]: 0.74-2.32), P=0.35; adjusted HR: 1.19 (95% CI: 0.61-2.31), P=0.61. Patients in the TEA group had significantly better pain relief during the first 24 h, but not thereafter, in open and minimally invasive procedures. There were no differences in postoperative complications, LOS, or RIOT between the groups.
CONCLUSIONS
There was no significant difference between the TEA and PCA groups in disease-free survival at 5 yr in patients undergoing surgery for colorectal cancer. Other than a reduction in postoperative pain during the first 24 h after surgery, no other differences were found between TEA compared with i.v. PCA with morphine.
Topics: Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Analgesia, Patient-Controlled; Anesthesia, Intravenous; Colorectal Neoplasms; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies
PubMed: 33966891
DOI: 10.1016/j.bja.2021.04.002 -
Yonsei Medical Journal May 2014This analysis was done to investigate the optimal regimen for fentanyl-based intravenous patient-controlled analgesia (IV-PCA) by finding a safe and effective background...
PURPOSE
This analysis was done to investigate the optimal regimen for fentanyl-based intravenous patient-controlled analgesia (IV-PCA) by finding a safe and effective background infusion rate and assessing the effect of adding adjuvant drugs to the PCA regimen.
MATERIALS AND METHODS
Background infusion rate of fentanyl, type of adjuvant analgesic and/or antiemetic that was added to the IV-PCA, and patients that required rescue analgesics and/or antiemetics were retrospectively reviewed in 1827 patients who underwent laparoscopic abdominal surgery at a single tertiary hospital.
RESULTS
Upon multivariate analysis, lower background infusion rates, younger age, and IV-PCA without adjuvant analgesics were identified as independent risk factors of rescue analgesic administration. Higher background infusion rates, female gender, and IV-PCA without additional 5HT₃ receptor blockers were identified as risk factors of rescue antiemetics administration. A background infusion rate of 0.38 μg/kg/hr [area under the curve (AUC) 0.638] or lower required rescue analgesics in general, whereas, addition of adjuvant analgesics decreased the rate to 0.37 μg/kg/hr (AUC 0.712) or lower. A background infusion rate of 0.36 μg/kg/hr (AUC 0.638) or higher was found to require rescue antiemetics in general, whereas, mixing antiemetics with IV-PCA increased the rate to 0.37 μg/kg/hr (AUC 0.651) or higher.
CONCLUSION
Background infusion rates of fentanyl between 0.12 and 0.67 μg/kg/hr may safely be used without any serious side effects for IV-PCA. In order to approach the most reasonable background infusion rate for effective analgesia without increasing postoperative nausea and vomiting, adding an adjuvant analgesic and an antiemetic should always be considered.
Topics: Adult; Aged; Analgesia, Patient-Controlled; Female; Fentanyl; Humans; Male; Middle Aged; Retrospective Studies; Sex Factors
PubMed: 24719151
DOI: 10.3349/ymj.2014.55.3.800 -
Biomedical Chromatography : BMC Apr 2022In this study, different injection solutions containing opioid and nonopioid compounds used for patient-controlled analgesia in hospice and palliative care were...
Stability evaluation of morphine, hydromorphone, metamizole and esketamine containing analgesic mixtures applied for patient-controlled analgesia in hospice and palliative care.
In this study, different injection solutions containing opioid and nonopioid compounds used for patient-controlled analgesia in hospice and palliative care were evaluated in terms of analyte stability. Investigated injection solutions contained different combinations of morphine, hydromorphone, metamizole and esketamine. For the practical implementation, samples from infusion pumps were daily drawn over a period of 7 days at 22 and 37°C. Quantitative measurements were performed on a high-performance liquid chromatography system with ultraviolet detection applying a validated analytical method. All compounds apart from morphine showed no evident changes in concentration. However, a significant loss of morphine was observed for injection mixtures containing both morphine and metamizole at 37°C. After 7 days, only 72% of the initially measured morphine concentration was measured in the binary and 77% in the ternary mixture. Furthermore, an additional compound was detected that could represent the morphine-metamizole-adduct, "metamorphine". Based on these results, a significantly reduced morphine concentration must be expected after only 3 days if an injection solution mixture containing both morphine and metamizole is administered to a patient at 37°C. Since the analgesic effects of morphine-metamizole adducts have not yet been thoroughly investigated, further clinical studies are necessary before accurate conclusions can be drawn in this regard.
Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Dipyrone; Hospices; Humans; Hydromorphone; Ketamine; Morphine; Palliative Care
PubMed: 35043434
DOI: 10.1002/bmc.5340 -
Anaesthesia Dec 1993A modified patient-controlled analgesia pump provided doses of propofol 3 mg or midazolam 0.1 mg in 0.3 ml, over 5.4 s, with no lockout, during transvaginal oocyte... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
A modified patient-controlled analgesia pump provided doses of propofol 3 mg or midazolam 0.1 mg in 0.3 ml, over 5.4 s, with no lockout, during transvaginal oocyte retrieval. Alfentanil 0.2 mg was administered at three points during the procedure, and on request. Patients were randomly assigned to receive either propofol (25 patients) or midazolam (22 patients). The mean age, weight, duration of procedure and dose of alfentanil were similar in both groups. Onset of sedation with propofol or midazolam took 70.6 (SD 22.4) and 106.3 (50.7) s respectively. Mean doses over the first 5 min were midazolam 2.7 (1.2) mg, and propofol 54 (18) mg. Thereafter requirements decreased: midazolam 0.065 (0.065) mg.min-1, propofol 2.1 (1.3) mg.min-1. All patients successfully completed the procedure; none required additional sedation. P-deletion, reaction time, and critical flicker fusion tests revealed similar depression in both groups immediately postoperatively. After 30 min the p-deletion and critical flicker fusion scores were still impaired in the midazolam, but not in the propofol, group.
Topics: Analgesia, Patient-Controlled; Female; Humans; Hypnotics and Sedatives; Infusion Pumps; Midazolam; Oocytes; Patient Satisfaction; Propofol; Psychomotor Performance; Time Factors
PubMed: 8285322
DOI: 10.1111/j.1365-2044.1993.tb07521.x