Patient-controlled analgesia versus intramuscular analgesic therapy

Smythe, Maureen A.; Loughlin, Kathleen A.; Schad, Randy F.; Lucarroti, Richard L.

doi:10.1093/ajhp/51.11.1433

Cited by 18 publications

(10 citation statements)

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“…Several studies have estimated the cost of an episode of IV PCA, 17,21,[95][96][97] and one recent German study estimated the cost of an episode of PCEA. 98 However, it is difficult to compare cost data between sites and countries, and comprehensive studies that have assessed all the direct (e.g., equipment, consumables) and indirect (e.g., staff time, hospital overhead) costs associated with administering PCA are few and far between.…”

Section: Discussionmentioning

confidence: 99%

“…morbidity compared with IM administration. 20,21 With regard to safety, adverse events encountered with IV PCA are generally those associated with opioid use, including nausea, vomiting, pruritus, constipation, sedation, and respiratory depression. 22 Among these adverse events, the most serious condition is respiratory depression, which may possibly lead to hypoxic injury as a result of opioid overdose.…”

Section: Intravenous Patient-controlled Analgesia (Iv Pca)mentioning

confidence: 99%

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Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

Viscusi¹

2008

Regional Anesthesia and Pain Medicine

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Postoperative pain management has dramatically improved with the advent of patient-controlled analgesia (PCA) delivery. The optimal PCA system would encompass several key characteristics, including consistent efficacy across a number of surgeries; safety of both the analgesic drug delivered and the delivery system; ease of setup, maintenance, and administration; patient comfort during analgesic delivery; avoidance of analgesic gaps; minimal invasiveness; and it would be associated with high patient satisfaction. Existing PCA modalities (using intravenous or epidural routes) encompass some of these characteristics (e.g., they have demonstrated efficacy across a number of surgeries); however, they are limited by the need for an indwelling catheter and the time and resources required for system setup and use. Device programming-related medication errors by hospital staff are an unfortunate risk, and could lead to significant harm. New PCA technologies are on the horizon that address some of the limitations to existing modalities; however, the added complexity of these newer systems are a concern, and their benefits and drawbacks remain to be assessed. These technologies include "smart" intravenous PCA infusion pumps to improve the safety of analgesic administration; needle-free options, such as the fentanyl HCl iontophoretic transdermal system for transdermal delivery; and a number of PCA devices for intranasal delivery, as well as several new options for patient-controlled regional analgesia. This review will discuss the benefits and drawbacks of both existing and emerging PCA modalities in the context of the ideal PCA system, and provide a critical evaluation of their use in postoperative settings.

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Section: Discussionmentioning

confidence: 99%

Section: Intravenous Patient-controlled Analgesia (Iv Pca)mentioning

confidence: 99%

Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

Viscusi¹

2008

Regional Anesthesia and Pain Medicine

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“…Although the number in this group is small (13 patients), this Finding concurs with the finding of Smythe et al and Thomas, who demonstrated inferior postoperative pain control with intramuscular opioids compared to intravenous (PCA) opioids. 10,11 Intra venous/intramuscular combinations were not commonly given together in the recovery room (two patients). • A high proportion (90%) of the patients who received nurse-administered intermittent intravenous bolus opioids were discharged 'comfortable'.…”

Section: Conclusion Discussion and Re-auditmentioning

confidence: 99%

Pain relief in the recovery room: an audit of current practice and a proposed solution

Simmonds

Edwards

1998

Journal of Clinical Effectiveness

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For this study 334 patients during their stay in the recovery room were assigned to the following groups: ‘comfortable’, in ‘pain’ and in ‘severe pain’. Fourteen per cent of patients awoke from anaesthesia in ‘pain’ and 10% were discharged to the ward in ‘pain’. Thirty‐seven per cent of patients using patient‐controlled analgesia (PCA) in the recovery room were discharged in ‘pain’; 63% of these patients had neither been prescribed nor given a ‘loading dose’ in the recovery room. Forty‐eight per cent of patients receiving sole intramuscular opioid analgesia were discharged in ‘pain’. Ninety per cent who received nurse‐administered ‘prn’ intravenous bolus opioids were discharged ‘comfortable’. An algorithm was therefore developed for the administration of loading doses of intravenous opioids in the recovery unit to be used by recovery nursing staff prior to PCA or other analgesic methods. An early re‐audit established that the algorithm became widely adopted by anaesthetists, was safe and produced comparable discharge pain scores.

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“…Smythe et al [72] compared the direct variable costs for intravenous morphine PCA to intramuscular meperidine [72]. Only costs immediately related to analgesic administration were included, e.g., medicine, tubing and pumps.…”

Section: Current Practicementioning

confidence: 99%

“…They calculated that this UK£3.50/patient is less than the cost of 30 min of nursing time and they 'suspected that the acute pain service saves at least 30 min of nursing time/patient by using more time-efficient methods of analgesic administration; so it is already cost-effective'. Other studies that measured or estimated nursing time have found that intravenous PCA was less time efficient than intramuscular analgesics [70][71][72]. The authors ignored any changes in patient care that may have resulted in other costs or savings, such as, shorter or longer lengths of stay or adverse effects.…”

Section: Current Practicementioning

confidence: 99%

Cost-effectiveness of different postoperative analgesic treatments

Engoren¹

2003

Expert Opinion on Pharmacotherapy

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Pain may produce metabolic changes after surgery, which may contribute to further morbidity. A variety of medicines and techniques can be used to successfully treat pain. It is postulated that improved analgesia leads to improved outcomes, although analgesics may also contribute to morbidity. This article reviews the literature evaluating the cost-effectiveness of providing different types of postoperative analgesics and finds that most studies are so poorly conducted that they prevent definitive conclusions being made. The author suggests that further studies be done using analgesics as just one part of a multimodal rehabilitation approach with careful attention to defining outcome, costs and achieving sufficient power to find or exclude meaningful differences.

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Patient-controlled analgesia versus intramuscular analgesic therapy

Cited by 18 publications

References 0 publications

Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

Pain relief in the recovery room: an audit of current practice and a proposed solution

Cost-effectiveness of different postoperative analgesic treatments

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