Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting

Morlion, Bart; Schäfer, Michael; Betteridge, Neil; Kalso, Eija

doi:10.1080/03007995.2018.1462785

Cited by 31 publications

(20 citation statements)

References 82 publications

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“…Minimum effective analgesic concentration (MEAC) is defined as the smallest concentration at which pain is relieved. PCA has evolved to include patient-controlled epidural analgesia (PCEA) or Epidural PCA, peripheral nerve catheter PCA or patient-controlled regional analgesia (PCRA), as well as a non-invasive method of transdermal PCA which delivers ionizable medications (fentanyl, for example) through the skin via iontophoresis and the application of an external electrical field [ 66 , 67 ].…”

Section: Analgesiamentioning

confidence: 99%

Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit

Egbuta

Mason

2021

JCM

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Critically ill pediatric patients often require complex medical procedures as well as invasive testing and monitoring which tend to be painful and anxiety-provoking, necessitating the provision of analgesia and sedation to reduce stress response. Achieving the optimal combination of adequate analgesia and appropriate sedation can be quite challenging in a patient population with a wide spectrum of ages, sizes, and developmental stages. The added complexities of critical illness in the pediatric population such as evolving pathophysiology, impaired organ function, as well as altered pharmacodynamics and pharmacokinetics must be considered. Undersedation leaves patients at risk of physical and psychological stress which may have significant long term consequences. Oversedation, on the other hand, leaves the patient at risk of needing prolonged respiratory, specifically mechanical ventilator, support, prolonged ICU stay and hospital admission, and higher risk of untoward effects of analgosedative agents. Both undersedation and oversedation put critically ill pediatric patients at high risk of developing PICU-acquired complications (PACs) like delirium, withdrawal syndrome, neuromuscular atrophy and weakness, post-traumatic stress disorder, and poor rehabilitation. Optimal analgesia and sedation is dependent on continuous patient assessment with appropriately validated tools that help guide the titration of analgosedative agents to effect. Bundled interventions that emphasize minimizing benzodiazepines, screening for delirium frequently, avoiding physical and chemical restraints thereby allowing for greater mobility, and promoting adequate and proper sleep will disrupt the PICU culture of immobility and reduce the incidence of PACs.

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Section: Analgesiamentioning

confidence: 99%

Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit

Egbuta

Mason

2021

JCM

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“…Hasta kontrollü analjezi, beş dekat önce kullanıma girmesinden bu yana etkili ve güvenli yeni sistemlerin de ilavesi ile non-invaziv olması, kolay kullanımı, erken hasta mobilizasyonuna izin vermesi gibi ek yararlar sağlamış ve ağrı tedavisinde multimodal yaklaşımın vazgeçilmez bir parçası olmuştur. [7] Hasta kontrollü analjezi uygulama- sından hastalar da memnun kalmakta, yeterli ağrı giderilmesi, güvenli hissetme, yan etkilerin az oluşu gibi nedenlerle konvansiyonel metotlara kıyasla HKA hastalar tarafından daha olumlu bulunmaktadır. [8] HKA uygulanan hastalar arasında yapılan bir araştırmada HKA hakkındaki "en iyi şey" sorulduğunda hastaların %50,5'i (n=100) "ağrıyı kontrol etmesi" olarak cevaplamış, HKA ile ilgili "en kötü şey" sorulduğunda ise hastaların %59,3'ü (n=118) "hoşlanmadığı bir şey bulamadığını" söylemiştir.…”

Section: Discussionunclassified

Postoperative Patient-Controlled Analgesia: A Single Center Experience

Şenaylı¹,

Salman

Şahin

2019

Journal of Contemporary Medicine

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Postoperatif hasta kontrollü analjezi uygulaması: Tek merkez deneyimi Postoperative patient-controlled analgesia: A single center experience Amaç: Bu retrospektif çalışmada postoperatif hasta kontrollü analjezi (HKA) uygulanan hastaların demografik özelliklerinin, ağrı durumlarının, kullanılan analjezik ajanların ve yan etkilerin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Hastanemizde Ocak 2000-Eylül 2001 tarihleri arasında yaklaşık 20 aylık periyotta HKA ile postoperatif analjezi tedavisi uygulanan hastalar retrospektif olarak değerlendirildi. Hastaların demografik bilgileri, klinik özellikleri, intravenöz veya epidural uygulama protokolleri kullanılarak servis şartlarında yaklaşık sekiz saat aralıklarla yapılan takip değerlendirme bulguları (ağrı, sedasyon, uykusuzluk, bulantı, kusma, kaşıntı) kaydedildi. Bulgular: Çalışmaya alınan 810 hastanın %57,9'u kadın olup çoğu (%55,8) ortopedik cerrahi uygulanmış olan hastalardı. Hasta kontrollü analjezi, 730 (%90,4) hastada intravenöz, 80 (%9,6) hastada epidural yol ile uygulanmıştı. İntravenöz HKA kadınlarda, epidural HKA ise erkeklerde daha fazla tercih edilen bir uygulama idi. En sık tercih edilen analjezik ajan intravenöz uygulamada petidin iken, epidural uygulamada fentanil + bupivakain olarak saptandı. Hastalarda en sık görülen yan etkiler sedasyon/uyku hali, bulantı, kusma ve idrar retansiyonu idi. Sonuç: Hastanemizde HKA uygulamasında intravenöz uygulamanın daha çok tercih edildiği, en sık tercih edilen analjezik ajanın intravenöz uygulamada petidin, epidural uygulamada fentanil + bupivakain olduğu görülmüştür. Hasta kontrollü analjezi ile ağrı tedavisi düşük yan etki düzeyleri ile iyi tolere edilmektedir. Anahtar Sözcükler: Hasta kontrollü analjezi, postoperatif ağrı, ağrı yönetimi Introduction: The aim of this retrospective study was to investigate demographic characteristics, pain conditions, analgesic agents used, and side effects in patients who received postoperative patient-controlled analgesia (PCA). Methods: Patients who received postoperative analgesia with PCA for approximately 20-month period, between January 2000 and September 2001, in our hospital were retrospectively evaluated. Demographic information, clinical features and follow-up evaluation findings (pain, sedation, sleeplessness, nausea, vomiting, itching), which were obtained in approximately eight-hour intervals under service conditions using intravenous or epidural administration protocols, were recorded. Results: Data of 810 patients were evaluated, of whom 57.9% were female and 55.8% underwent orthopedic surgery. PCA was administered by intravenous route in 730 patients (90.4%) and by epidural route in 80 patients (9.6%). Intravenous PCA was preferred more in females and epidural PCA was preferred more in males. While the most preferred analgesic agent was petidine in the intravenous PCA, it was fentanil + bupivacaine in the epidural PCA. The most common side effects were sedation/somnolence, nausea, vomiting, and urinary retention. Discussion and Conclusion: In our hospital, it was se...

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“…The restrictions placed on the distribution and use of sufentanil sublingual tablets may limit some of these uses. 3-8…”

Section: Indicationsmentioning

confidence: 99%

Formulary Drug Review: Sufentanil Sublingual

Baker

2019

Hosp Pharm

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Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting

Cited by 31 publications

References 82 publications

Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit

Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit

Postoperative Patient-Controlled Analgesia: A Single Center Experience

Formulary Drug Review: Sufentanil Sublingual

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