Pain management in cardiac surgery patients: Comparison between standard therapy and patient-controlled analgesia regimen

Boldt, Joachim; Thaler, Elfi; Lehmann, Andreas; Papsdorf, Michael; Isgro, Frank

doi:10.1016/s1053-0770(98)90237-3

Cited by 60 publications

(30 citation statements)

References 17 publications

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“…3 Sedation scores at baseline (preoperatively before gabapentin), before induction, following extubation, and on postoperative day one (mean ± SD) scale when measured on postoperative day one. 13 In contrast, our scores were 1.1 ± 1.0 and 1.1 ± 0.32, respectively. In addition, the total morphine equivalents administered in our investigation (22.7 ± 18.1 mg or 0.95 mgÁhr -1 ) were similar to those of Parlow et al 14 (0.78 mgÁhr -1 weighted average) but lower than those reported by Coventry et al 15 (1.27 mgÁhr -1 ).…”

Section: Discussioncontrasting

confidence: 67%

“…27,28 Limitations of this study include its observational unblinded design; it was not intended to assess analgesic efficacy. However, it is noted that pain scores may be lower 13 and opioid requirements appeared to be at least comparable with 14 or lower 15 than those reported in previous studies observing patients during CPB in the absence of gabapentin. In addition, a thorough pharmacokinetic analysis was not carried out, as the objective was to determine possible effects of CPB on gabapentin blood concentration.…”

Section: Discussionmentioning

confidence: 48%

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Cardiopulmonary bypass does not affect plasma concentration of preoperatively administered gabapentin

Parlow

Gilron

Milne

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Drug effects can be unpredictable during cardiac surgery due to factors that may influence drug concentration, such as extracorporeal oxygenation and hemodilution. The primary aim of the current investigation was to determine whether plasma gabapentin concentration is altered by cardiopulmonary bypass (CPB). Methods Following approval from the Research Ethics Board and written informed consent, we conducted this open-label prospective cohort investigation. A convenience sample of 16 patients, who were scheduled for coronary bypass surgery, received oral gabapentin 600 mg as follows: 90 min prior to induction of anesthesia, following tracheal extubation, and then every eight hours for a total of four doses. Plasma gabapentin concentration, as well as pain and sedation scores, were documented. Results Plasma gabapentin concentrations were unaltered during CPB (31.9 ± 12.7 lmolÁL -1 prior to CPB, 35.6 ± 12.9 to 37.2 ± 9.6 lmolÁL -1 during CPB). However, using the current protocol, drug accumulation (reflected by increased drug concentrations) was observed following the third (58.2 ± 19.5 lmolÁL -1 ) and the fourth (71.9 ± 34.3 lmolÁL -1 ) doses. Pain and sedation scores and opioid requirements were comparable with those found in other studies. Conclusion Plasma gabapentin concentration is unaltered during CPB following preoperative administration.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 48%

Cardiopulmonary bypass does not affect plasma concentration of preoperatively administered gabapentin

Parlow

Gilron

Milne

et al. 2010

Can J Anesth/J Can Anesth

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“…The data reveal the effectiveness of PCA in the arena of pain control. This has been reported in many studies previously, most of which were carried out in post-operative settings (13). Patients using PCA in our study had control of their pain at the push of a button, and in hospitals with staff shortages, use of PCA may save time for the medical staff to attend to other emergent matters.…”

Section: Discussionsupporting

confidence: 67%

A Randomized Controlled Trial of Patient-controlled Analgesia Compared with Boluses of Analgesia for the Control of Acute Traumatic Pain in the Emergency Department

Rahman

DeSilva

2012

The Journal of Emergency Medicine

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“…14 This left ten eligible trials, including nine papers [15][16][17][18][19][20][21][22][23] and one abstract 24 involving a total of 666 patients (Table I). The median Jadad score was 3 (range: 2-4).…”

Section: Resultsmentioning

confidence: 99%

Patient-controlledversus nurse-controlled analgesia after cardiac surgery — a meta-analysis

Bainbridge¹,

Martin

Cheng³

2006

Can J Anesth/J Can Anesth

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Background: Patient-controlled analgesia (PCA) has been advocated as superior to conventional nurse-controlled analgesia (NCA) with less risk to patients. This systematic review and meta-analysis sought to determine whether PCA improves clinical and resource outcomes when compared with NCA. Methods:A comprehensive search was undertaken to identify all randomized controlled trials of PCA vs NCA. Medline, Cochrane Library, Embase, and conference abstract databases were searched from the date of their inception to August 2005. The primary postoperative outcome was defined as mean visual analogue scale (VAS) scores. Secondary postoperative outcomes included cumulative morphine equivalents, intensive care unit (ICU) and hospital length of stay, postoperative nausea and vomiting, sedation, respiratory depression, and all-cause mortality. Odds ratios or weighted mean differences (WMD) and their 95% confidence intervals (CI) were calculated for discrete and continuous outcomes, respectively.Results: Ten randomized trials involving 666 patients were included. Compared to NCA, PCA significantly reduced VAS at 48 hr (WMD -0.73, 95% CI -1.19, -0.27), but not at 24 hr (WMD -0.19, 95% CI -0.61, 0.24). Cumulative morphine equivalents consumed were significantly increased at 24 hr (WMD 6.84 mg, 95% CI 0.97, 12.72 mg), and at 48 hr (WMD 10.46 mg 95% CI 2.02, 18.9 mg) for PCA compared with NCA. Ventilation times, length of ICU stay, length of hospital stay, patient satisfaction scores, sedation scores, and incidence of postoperative nausea and vomiting, respiratory depression, severe pain, discontinuations, and death were not significantly different between groups, but these outcomes were generally under-reported. Conclusions:In postcardiac surgical patients, PCA increases cumulative 24 and 48 hr morphine consumption, and improves 48-hr VAS compared with NCA. Objectif

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Pain management in cardiac surgery patients: Comparison between standard therapy and patient-controlled analgesia regimen

Cited by 60 publications

References 17 publications

Cardiopulmonary bypass does not affect plasma concentration of preoperatively administered gabapentin

Cardiopulmonary bypass does not affect plasma concentration of preoperatively administered gabapentin

A Randomized Controlled Trial of Patient-controlled Analgesia Compared with Boluses of Analgesia for the Control of Acute Traumatic Pain in the Emergency Department

Patient-controlledversus nurse-controlled analgesia after cardiac surgery — a meta-analysis

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