Patient-Controlled Analgesia in Postoperative Cardiac Surgery

Abstract

The purpose of this study was to assess, in the early postoperative period of cardiac surgery, the efficacy of patientcontrolled analgesia (PCA) versus nurse-administered intravenous morphine followed by oral acetaminophen with or without codeine. Patients undergoing coronary bypass and/or valvular surgery were recruited. All were under 75 years of age and were in stable angina with no ischaemic attacks within the last three months. Visual analog scores (VAS) were used for pain assessment. Pulmonary function tests were done preoperatively and measured every six hours after surgery until discharge from the intensive care unit. Patients allocated to the PCA group received morphine intravenously by a PCA Plus Micro Delivery Device for at least 48 hours. Patients entered into the nurse-administered intravenous morphine group received intravenous morphine followed by oral acetaminophen with or without codeine in 24 to 36 hours according to the clinical assessment of the critical care nurse. The data showed that the quality of pain control and pulmonary function were comparable in both groups. The equipotent morphine dosage requirements were also not statistically different. It was concluded that there was no significant advantage in using PCA routinely in the early postoperative period after cardiac surgery. Furthermore, repetition of PCA instructions was often required during the study period.

Une perfusion de morphine améliore l’analgésie autocontrôlée après cardiochirurgie

“…[1][2][3][4] Although the use of patient-controlled analgesia (PCA) is well established for major abdominal and orthopedic surgeries, [3][4][5][6] little has been published about its use after cardiac surgery. [7][8][9][10][11][12][13] Conventional bolus PCA may be less effective because of disorientation in the intensive care unit (ICU) environment, and poor retention of preoperative learning. 11 The addition of a background morphine infusion to morphine PCA may improve patient analgesia and comfort.…”

Five-day pain management regimen using patient-controlled analgesia facilitates early ambulation after cardiac surgery

“…Patients in the phase 1 group, who discontinued the PCA system at 40 h, showed considerably higher VAS scores at POD 3-5 and frequently required additional analgesic drugs, including oral NSAIDs or intravenous pentazocine. Although previous investigations of intravenous PCA discontinued the PCA at POD 2-3 [12][13][14][15][16], we consider that employing PCA for only 2-3 days after cardiac surgery is not sufficient. Similarly, when thoracic epidural analgesia (TEA) was discontinued at POD 3, it did not shorten the length of hospital stay or rehabilitation procedure [17].…”

Patient-Controlled Analgesia

“…However, several studies have reported no significant difference in terms of analgesic efficacy [7,8,48,50,52]. It should be noted that in these latter studies, the authors paid particular attention to care by conventional analgesia.…”

“…Walder et al in a recent meta-analysis which included 2, 111 patients [5], analyzed the studies comparing PCA with conventional opioid analgesia nurse administered by intramuscular [7,8,46,47], subcutaneous [48] or intravenous [49,50] routes or by continuous perfusion [51,52].…”

“…It should be noted that in these latter studies, the authors paid particular attention to care by conventional analgesia. For example, in three of the studies [48,50,52], patients were in intensive care settings where there are usually higher nurse/patient ratios than in general hospital wards, providing closer nursing supervision and optimal pain management. Interestingly, pain relief using PCA was comparable with that obtained from nursemanaged IV opioids when the nurse/patient ratio was 1:1 (for instance in an intensive care unit); in contrast, PCA was superior when this ratio decreased (for instance in a general ward) [53].…”