Introducing patient‐controlled analgesia for postoperative pain control into a district general hospital

Notcutt, William; Morgan, Ross

doi:10.1111/j.1365-2044.1990.tb14787.x

Cited by 95 publications

(20 citation statements)

References 11 publications

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“…5 Although i.v. PCA represents a well-accepted and satisfactory means of acute pain treatment, 6,7 individual case reports [8][9][10][11][12][13][14][15][16][17][18][19][20][21] and larger case series 8,22,23 have described the occurrence of i.v. PCA-related ADEs resulting from operator error, patient error, or device malfunction.…”

mentioning

confidence: 99%

Adverse events involving intravenous patient-controlled analgesia

Hankin¹,

Schein

Clark³

et al. 2007

American Journal of Health-System Pharmacy

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mentioning

confidence: 99%

Adverse events involving intravenous patient-controlled analgesia

Hankin¹,

Schein

Clark³

et al. 2007

American Journal of Health-System Pharmacy

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“…While the number of reports of 'run-away' pumps, where the PCA pump unexpectedly delivers an unprescribed dose of drug (Notcutt & Morgan, 1990), has decreased following changes made to pump design, they continue to occur, including a report of spontaneous triggering (Christie & Cranfield, 1998) and of a frayed wire in the demand apparatus leading to triggering as a result of an electrical short circuit (Doyle & Vicente, 2001). …”

Section: Equipment-related Complicationsmentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…However, several retrospective observational studies involving almost 10,000 adult patients showed an increased incidence of not only mild or moderate adverse events, such as nausea and sedation, but also severe adverse events, such respiratory depression with hypoxemia, with no increase in efficacy, with the addition of a background infusion. [3][4][5][6] The recently updated guidelines for perioperative pain management from the American Society of Anesthesiologists do not recommend the use of a background infusion, because there appears to be no additional analgesic benefit. 7 In contrast, BACKGROUND: Bolus administration of opioids via a patient-controlled analgesia (PCA) device is widely used in the postoperative pediatric population.…”

mentioning

confidence: 99%