Patient-controlled Analgesia Consumption Research Articles

Comparison of the analgesic efficacy of ketobemidone and morphine for management of postoperative pain in children: a randomized, controlled study

Ketobemidone has been used as an analgesic for postoperative pain in children, but to our knowledge the effect and occurrence of adverse effects of ketobemidone compared to morphine is not known. The aim was to determine if the analgesic potency and the occurrence of adverse effects of ketobemidone differ from morphine when administered to children, as measured by patient-controlled analgesia consumption (PCA) for postoperative pain. Sixty healthy children, aged 6 to 16 years, scheduled for elective surgery were randomized to receive either ketobemidone (Ke) 1 mg ml(-1) or morphine (Mo) 1 mg ml(-1) for postoperative pain through PCA. Drug consumption (microg kg(-1) h(-1)), the number of PCA doses, pain intensity, and adverse effects were recorded at regular intervals. Data on total drug consumption were based on 26 children in the Ke group and 28 in the Mo group. A non-statistically significant difference for total mean consumption of ketobemidone (18.6 microg kg(-1)h(-1)) and morphine (23.2 microg kg(-1)h(-1)) was obtained. The mean dose ratio (Mo/Ke) was 0.80 and the median was 0.94. Children's characteristics, loading dose, PCA doses, VAS scores, and adverse effects showed no significant differences between the groups. The analgesic potency and adverse effects of ketobemidone are similar to morphine when used for postoperative pain management in children.

Comparison of morphine/droperidol and tramadol/droperidol mixture for patient controlled analgesia (PCA) after cardiac surgery: a prospective, randomised, double-blind study

Abstract Aim: To determine whether a tramadol/droperidol PCA is as efficacious but causes less respiratory depression and sedation than a morphine/droperidol PCA in post cardiac surgical patients. Methods: A single centre, randomised double-blind study of 40 patients was performed. Group one or control (20) patients received a morphine/droperidol PCA and group two or experimental patients received a tramadol/droperidol PCA after cardiac surgery. PCA was commenced after extubation in the ICU, as is normal practice at this institution. Study continued for 24 h and the following data was collected; PCA consumption, pain, nausea and sedation scores as well as patient satisfaction/recovery (QoRS) score. Results: No difference between groups was detected for demographic variables. There was no statistically significant difference between groups for dose or duration of PCA use or in recorded pain scores. The morphine group had a significantly higher QoRS score. Both groups had a very low incidence of nausea. Conclusion: Tramadol/droperidol PCA does not confer a better recovery after cardiac surgery when compared to morphine/droperidol PCA.

No pain, no gain: clinical excellence and scientific rigour – lessons learned from IA morphine

The effectiveness of intra-articular (IA) morphine in arthroscopic procedures of the knee joint was analysed in all randomised and controlled trials that included injections of morphine and placebo into the knee joint, and where the data were analysable. Sensitivity of the studies and effectiveness were analysed for three different periods: immediate (0–2 h), early (2–6 h) and late (6–30 h). Sensitivity for each period was assumed if pain intensity was at least 30% of the maximum of 100 on the visual analogue scale in the placebo group. Six different doses (1–10 mg) of IA morphine were compared with placebo. The injections were made at the end of surgery, before the arthroscope was removed from the joint. In the immediate period 7/15 sensitive trials were positive, in the early period 8/12 sensitive trials were positive and in the late period 10/13 sensitive trials were positive. Most positive studies had used higher doses (3–5 mg) compared with negative studies that had mainly used 1 mg. Two studies using patient controlled analgesia consumption of analgesics as an outcome were also positive. The only sensitive study of four dose–response comparisons indicated that 5 mg of IA morphine was more effective than 1 mg. The only sensitive study of three cross-route comparisons showed no difference between 5 mg of IA and 5 mg of intra-muscular morphine. All insensitive trials, including placebo (except two individual comparisons), cross-route and dose–response comparisons, were negative. The analysis of sensitive studies indicates that 5 mg of IA morphine injected into the knee joint provides postoperative pain relief for up to 24 h. A minimum of 30% of the maximum possible pain intensity is needed for an analgesic effect to be detected in a study.

The Efficacy of Intrathecal Neostigmine, Intrathecal Morphine, and Their Combination for Post-Cesarean Section Analgesia

We designed this study to evaluate the postoperative analgesic efficacy and safety of intrathecal (IT) neostigmine, IT morphine, and their combination in patients undergoing cesarean section under spinal anesthesia.Seventy-nine term parturients were randomly divided into four groups to receive isotonic sodium chloride solution 0.2 mL, neostigmine 25 [micro sign]g, morphine 100 [micro sign]g, or the combination of IT neostigmine 12.5 [micro sign]g and morphine 50 [micro sign]g with IT 0.5% hyperbaric bupivacaine 12 mg. There were no significant differences among the four groups with regard to spinal anesthesia, maternal blood pressure and heart rate, or fetal status. Postoperative analgesia was provided by IV patient-controlled analgesia (PCA) using fentanyl and ketorolac. Compared with the saline group, the time to first PCA use was significantly longer in the neostigmine group (P < 0.001), with lower 24-h analgesic consumption (P < 0.001). Nausea and vomiting were the most common side effects of IT neostigmine (73.7%). Analgesic effectiveness was similar between the neostigmine and morphine groups. Compared with the neostigmine group, the combination group had significantly prolonged analgesic effect and reduced 24-h PCA consumption (P < 0.05) with less severity of nausea and vomiting (P = 0.058). Compared with the morphine group, the combination group tended to have prolonged times to first PCA use (P = 0.054) with a lower incidence of pruritus (P < 0.03). Implications: Intrathecal (IT) neostigmine 25 [micro sign]g produced postoperative analgesia for cesarean section similar to that of IT morphine 100 [micro sign]g, but with a high incidence of nausea and vomiting. The combination of IT neostigmine 12.5 [micro sign]g and IT morphine 50 [micro sign]g may produce better postoperative analgesia with fewer side effects than IT neostigmine 25 [micro sign]g or IT morphine 100 [micro sign]g alone. (Anesth Analg 1998;87:341-6)

Surgical wound pain: a trial of two treatments

In order to compare postoperative incisional pain intensity, a prospective randomised controlled trial was conducted with two patient groups: a treatment group (treated with a film dressing left intact until suture removal) and a control group (treated with the existing wound-care protocol of a dry dressing removed after 48 hours). Patient-controlled analgesia consumption and infection rates in the two groups were also compared. A sample of 30 patients undergoing total abdominal hysterectomy was selected. Incisional wound pain, measured using a visual analogue scale (at rest, on movement and a 24-hour average) and the McGill Pain Questionnaire were recorded daily until discharge (four days). The pain scores were not significantly different between the groups on Days 1 or 2 postoperatively. However, on Day 3 (when the wounds in the dry dressing group were exposed), there was a statistically significant difference in 24-hour average pain. Those whose wounds were covered with the film dressing experienced less pain and requested fewer non-steroidal anti-inflammatory drugs on Day 3. Maintaining a cover over a surgical wound until suture removal appears to promote pain relief when compared to exposing wounds to the air. A film dressing was useful in this respect as it allowed inspection of the wound without removing the dressing.