Ppn3 Summary of Hospital Logistics Associated With Intravenous Patient-Controlled Analgesia (Iv Pca) for Acute Postoperative Pain Management

Zhang, M; Anastassopoulos, Kathryn; Hutchison, R.; Olson, WH; Goss, TF; Hewitt, D; Gargiulo, Kathryn; Siccardi, Mariana; Mordin, Margaret

doi:10.1016/s1098-3015(10)63119-1

Cited by 1 publication

(4 citation statements)

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“…Fifty-four percent of hospitals continue to use prefilled cartridges of meperidine despite the pharmacotherapy evidence for risk of central nervous system toxicity. 14 Meperidine was not considered in this study, due the inherent risk of accumulation of the central nervous system toxic metabolite, normeperidine. 2–3…”

Section: Discussionmentioning

confidence: 99%

“…In US hospitals, the frequency of IV PCA opioid use in descending order is morphine, meperidine, hydromorphone, and fentanyl. 1 Fentanyl PCA in acute post-operative pain management is under utilized. The under use was in part due to low availability of a premixed fentanyl cartridge.…”

Section: Discussionmentioning

confidence: 99%

“…In recent survey of US hospitals, only 8% of the hospitals used prefilled fentanyl PCA, and 39% used staff-prepared fentanyl PCA. 1 A new fentanyl patient controlled transdermal system (PCTS), IONSYS , recently approved by the FDA, is another PCA option. The fentanyl PCTS has been studied for use in the management of acute pain.…”

Section: Discussionmentioning

confidence: 99%

“…By tradition, morphine is the most commonly utilized opioid in this setting, yet studies providing evidence based selection of morphine as the preferred opioid are lacking. 1–2 Meperidine should not be considered in the PCA armamentarium due to the associated risk of central nervous system toxicity from its metabolite normeperidine. 35 The objective of this study is to compare the rate of opioid-induced adverse reactions (OIAR) among three IV PCA opioids, fentanyl, morphine, and hydromorphone in acute post-operative pain management.…”

mentioning

confidence: 99%

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A Comparison of a Fentanyl, Morphine, and Hydromorphone Patient-Controlled Intravenous Delivery for Acute Postoperative Analgesia: A Multicenter Study of Opioid-Induced Adverse Reactions

et al. 2006

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Patient-controlled analgesia (PCA) is a widely used delivery system for intravenous (IV) administration of opioids during acute post-operative pain management. Various opioids have been used for IV PCA including morphine, meperidine, hydromorphone, and fentanyl. Morphine is by far the most commonly used opioid in this setting, yet the selection of morphine as the primary opioid is based largely on tradition. Meperidine should not be considered in the PCA armamentarium due to the associated risk of central nervous system toxicity from its metabolite normeperidine. The objective of this study is to compare the rate of opioid-induced adverse reactions among three IV PCA opioids, fentanyl, morphine, and hydromorphone, in acute post-operative pain management. Although morphine is the most frequently used opioid, the results from three US hospitals indicate that fentanyl IV PCA had a significantly lower rate of common opioid induce adverse reactions (nausea/vomiting, pruritus, urinary retention, or sedation), when compared to IV PCA morphine and hydromorphone in acute post-operative pain management. The median pain score on post-operative day-1 and -2 was significantly lower in fentanyl IV PCA group. The quantity of opioid in each group was not significantly different when converted to an analgesic equivalence. Morphine and hydromorphone IV PCA were no different in rates of adverse reactions in any area; although, the hydromorphone group trended toward a lower pruritus and urinary retention rate compared to morphine, but this was not statistically significant. The rate of respiratory depression was not significantly different between the three opioids. Fentanyl IV PCA is an under used opioid for post-operative acute-pain management and should be considered more often due to the lower adverse reaction profile.

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