Randomised controlled trial of patient controlled analgesia compared with nurse delivered analgesia in an emergency department

Abstract

Objective: To compare effectiveness, safety, and patient satisfaction of patient controlled analgesia (PCA) with titrated, intravenous opioid injections for the management of acute traumatic pain in the emergency department (ED). Methods: The study took place in the ED of a teaching hospital. Patients suffering traumatic injury requiring opioid analgesia, and meeting other inclusion criteria, were consented and randomised to either the study group or control group. The study group were given morphine through the PCA system, whereas the control group were given morphine via the conventional route of nurse titration. Pain levels were measured using a visual analogue scale. Both groups had their vital signs (blood pressure, pulse, oxygen saturations, Glasgow coma score, respiratory rate) and pain scores monitored at 0, 15 , 30, 45, 60, 90, and 120 minutes, and any adverse events were noted. Patients were followed up with a questionnaire asking about their experience of pain relief in the department. Results: 86 patients were recruited to the study, 43 in each group. There was no significant difference between the groups in terms of pain relief (p = 0.578) and patient satisfaction (p = 0.263). No severe adverse events were observed, although 20.7% (n = 9) of the PCA group experienced mild sedation compared with 7% (n = 3) of the control group. Conclusions: PCA is at least as effective as titrated intravenous injections for relief of traumatic pain. It has considerable potential for use in the ED.

Efficacy of Patient‐controlled Analgesia for Patients With Acute Abdominal Pain in the Emergency Department: A Randomized Trial

“…To the best of our knowledge, few prior published studies have evaluated application of PCA to this setting. Evans et al 9 reported on the results of an ED trial that included 86 trauma patients randomized to receive either PCA or nursetitrated analgesics. These authors did not find a significant difference between groups with respect to pain relief or patient satisfaction, but concluded that PCA is at least as effective as titrated IV injections and has considerable potential for use in the ED.…”

“…A further limitation of the study by Evans et al is a relatively small sample size, which was underpowered to detect potentially significant differences between the two treatment groups in efficacy. 9 Another comparison of intermittent IV morphine injection compared to PCA at two doses in ED sickle cell patients was similarly limited by small numbers of patients (10 to 13 per group), low power, and small PCA loading doses (2 or 5 mg morphine). 10 These Data reported as n (%) except as noted.…”

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

“…Few data have been published on the use of PCA in the ED. Evans et al in 2005 reported that they found no significant difference between the usage of PCA vs. boluses of intravenous analgesia (6). So far, the use of PCA in the fields of anesthesia and surgery has proven to be most effective in terms of pain relief and patient satisfaction.…”

Acute pain management with intravenous 0.10mg/kg versus 0.15mg/kg morphine sulfate in limb traumatized patients: A randomized double-blinded placebo-controlled trial

“…The VAS pain score is the most commonly used tool to assess pain, is sensitive to small changes, and provides a continuous variable suitable for statistical analysis. [11] It has been widely accepted due to its ease and brevity of administration, minimal intrusiveness, and conceptual simplicity. [12] The VAS pain intensity measurement was administered at baseline (before morphine at 0.10 mg/kg), 30 minutes from baseline (just before study drug administration), and at 60 minutes from baseline (30 minutes after the study drug).…”