Measuring pain as the 5th vital sign does not improve quality of pain management

Mularski, Richard A.; White-Chu, Foy; Overbay, Devorah; Miller, Lyndsey M.; Asch, Steven M.; Ganzini, Linda

doi:10.1111/j.1525-1497.2006.00415.x

Cited by 314 publications

(258 citation statements)

References 16 publications

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“…5,6 On the same occasions, venous blood samples were collected for measurement of plasma fentanyl concentrations. The blood samples were immediately centrifuged and the plasma was separated and stored at -70 °C until the time for spectrochromatography analysis.…”

Section: Methodsmentioning

confidence: 99%

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

et al. 2010

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CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING:A randomized double-blind study was performed in Hospital São Paulo. METHODS:During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14) received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15) received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS:The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4%) than in group 2 (100%): 95% confidence interval (CI) = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07). Epidural bupivacaine supplementation was also lower in group 1 (14.3%) than in group 2 (53.3%): 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26). There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups.CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used. CLINICAL TRIAL REGISTRATION NUMBER: NCT00635986RESUMO CONTEXTO E OBJETIVO: Existem controvérsias sobre o local de ação do fentanil injetado por via peridural. O objetivo foi comparar a eficácia do fentanil peridural e do venoso em cirurgias ortopédicas. TIPO DE ESTUDO E LOCAL:Estudo aleatório, duplo-cego, realizado no Hospital São Paulo. MÉTODO:No pós-operatório, na presença de dor, 29 pacientes foram divididos em dois grupos: grupo 1 (n = 14) recebeu solução de 100 mcg de fentanil por via peridural e 2 ml de solução salina venosa; grupo 2 (n = 15), 5 ml de solução salina peridural e 100 µg de fentanil venoso. A complementação analgésica foi com 40 mg de tenoxicam venoso e, se necessário, 5 ml de bupivacaína 0.25%. A intensidade da dor foi avaliada pela escala numérica e a concentração plasmática do fentanil foi medida simultaneamente.RESULTADOS: A percentagem de pacientes que necessitaram de complementação analgésica com tenoxicam foi menor no grupo 1 (71.4% versus 100.0% grupo 2): intervalo de confiança, IC 95% = 0.001-0.4360 (P = 0.001, teste exato de Fisher; risco relativo, RR = 0.07). A complementação com bupivacaína peridural também foi menor no grupo 1 (14.3% versus 53.3% grupo 2): IC 95% = 0.06-1.05 (P = 0.03, teste exato de Fisher; RR = 0.26).Não houve diferença na intensidade da dor avaliada pela escala numérica. As concentrações plasmáticas do fentanil foram semelhantes nos dois grupos.CONCLUSÃO: A eficácia do...

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Section: Methodsmentioning

confidence: 99%

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

et al. 2010

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“…17 For example, near-universal implementation of a visual analog pain scale in the VA health system nationally was not associated with improvement in clinical care for pain. 18 Clinical care improvement requires education about interpretation of the assessment or monitoring tests, as well as effective communication skills in talking to patients about concerns about opioid misuse. Urine drug testing in particular is quite complex, and requires knowledge of the opioid chemical derivative (e.g.…”

mentioning

confidence: 99%

Safe Opioid Prescribing: A Long Way to Go

Liebschutz

Alford

2011

J GEN INTERN MED

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“…Andererseits konnte mehrfach gezeigt werden, dass die Einführung einer Routineschmerzmessung nicht automatisch eine Verbesserung der Schmerztherapie zur Folge hat [3], sondern -gerade in Zusammenhang mit einer Zertifizierungmöglicherweise sogar zu einer Patientengefährdung führt [4]. Zudem unterschied sich die Ergebnisqualität weder in deutschen noch in internationalen Registerdaten auch nur tendenziell zwischen Patienten mit und ohne Routineschmerzmessung [5,6] Aber was ist eigentlich gute Qualität in der Schmerzmedizin?…”

Section: Qualität In Der (Akut-)schmerztherapie Plädoyer Für Einen Paunclassified

Qualität in der (Akut-)Schmerztherapie

Meißner

2012

Schmerz

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Measuring pain as the 5th vital sign does not improve quality of pain management

Abstract: Routinely measuring pain by the 5th vital sign did not increase the quality of pain management. Patients with substantial pain documented by the 5th vital sign often had inadequate pain management.

Cited by 314 publications

References 16 publications

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

Safe Opioid Prescribing: A Long Way to Go

Qualität in der (Akut-)Schmerztherapie

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