New Developments in Patient-controlled Postoperative Analgesia

Abstract

Patient-controlled analgesia (PCA) is a newer technique for pain management. Patients are allowed to self-administer small analgesic bolus doses into a running intravenous infusion, intramuscularly, subcutaneously or even into the epidural space. Demands are usually controlled by computer-driven infusion pumps, but can also be delivered by disposable devices. Clinical experience demonstrates that individual variability in pain sensitivity and analgesic needs are of utmost importance. In contrast to earlier expectations, opioid consumption is usually higher than with restrictive conventional dosing regimes, but without an increase in serious side effects. Patients' acceptance is generally enthusiastic because of the possibility of self-control. PCA has proved its importance for pain studies, e.g. for algesimetry, to determine predictors of postoperative pain, to describe drug interactions, to evaluate the concept of pre-emptive analgesia or for pharmacokinetic designs. It is concluded that PCA results have been urgently required in order to change the mind of physicians and nursing staff with respect to individual pain management strategies. Once this goal is achieved, PCA concepts should also be used for the improvement of more conventional techniques.

Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy

“…In the present study no differences were found in the VRS or VAS scores on postoperative pain at rest or swallowing. According to our results, it can be assumed that differences in oxycodone consumption indicate the analgesic efficacy of the study drugs (9).…”

Reproducible fentanyl doses delivered intermittently at different time intervals from an electrotransport system

“…4 Analgesic delivery systems that are controlled by the patient (patient-controlled analgesia or PCA) provide better pain control than standard modes of delivery because they allow continuous patient access to pain medication within predetermined limits. 1 Such PCA systems are both efficacious and well accepted. The PCA systems are fully computerized portable syringe pumps with a reservoir for the drug solution.…”

Postoperative Schmerztherapie mit Hydromorphon und Metamizol

“…Für Alfentanil, Buprenorphin, Fentanyl, Metamizol, l-Methadon, Morphin, Nalbuphin, Nefopam, Pentazocin, Pethidin, Piritramid und Sufentanil sind entsprechende Befunde verfügbar [17]. Vornehmlich ging es darum, unter einheitlichen Bedingungen die analgetische Potenz, Ver-träglichkeit und Patientenakzeptanz zu bestimmen.…”