Randomized Trial of Postoperative Patient-Controlled Analgesia vs Intramuscular Narcotics in Frail Elderly Men

Egbert, Anne M.; Parks, Leland H.; Short, Lois; Burnett, Mary Lynn

doi:10.1001/archinte.1990.00390200083016

Cited by 145 publications

(30 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, PCA resulted in fewer severe pulmonary complications [22]. In contrast, another study in patients over 70 years of age failed to find any improvement in cognitive function [59].…”

Section: Pca Versus Conventional Opioid Analgesiamentioning

confidence: 94%

“…However, in opioid-tolerant patients, a background infusion may be added to deliver the equivalent of the usual opioid dose taken by the patient [6]. In the elderly, it has been proposed that an initial fixed morphine bolus of 0.01 mg/kg with a 10-min lockout period be regularly adapted according to the signs of efficacy or overdosing [22]. In clinical practice however, the PCA setting is commonly equivalent to that used for young adults [23][24][25].…”

Section: Pca Settingmentioning

confidence: 99%

“…Postoperative confusion has been observed in only 2.3% of the patients over 60 years of age receiving PCA compared with 18% in those given conventional analgesia [22]. In addition, PCA resulted in fewer severe pulmonary complications [22].…”

Section: Pca Versus Conventional Opioid Analgesiamentioning

confidence: 99%

“…In the elderly, this situation concerns not only patients presenting dementia but more generally, those presenting cognitive troubles. Thus, 17.5% of the patients > 60 years would have problems initiating PCA bolus doses on the first day because of mild confusion [22]. The routine preand postoperative use of mental assessment (e.g., the Mini Mental State Examination or the Abbreviated Mental Test) is recommended as an effective strategy to take care of pain management in elderly patients [25,70].…”

Section: Limitation Of Pcamentioning

confidence: 99%

“…It should be emphasized that for patients who exhibit pre-or postoperative cognitive impairment or physical disabilities, pain management must rely on the judgment of physicians and nurses, and requires a conventional analgesia strategy. In contrast, healthy old patients can manage PCA successfully, and PCA should not be withheld simply on the basis of age [22,25,71]. However, the age-related changes in the pharmacokinetic and pharmacodynamic constants of opioids may need to be taken into account when PCA is prescribed in old patients.…”

Section: Limitation Of Pcamentioning

confidence: 99%

See 4 more Smart Citations

Patient-Controlled Analgesia

Mann¹,

Ouro-Bang'na²,

Eledjam

2005

CDT

View full text Add to dashboard Cite

Using a portable infusion pump, intravenous opioid patient-controlled analgesia (PCA) permits a patient to self-deliver a small bolus of opioid to achieve prompt relief without over sedation. Use of PCA for pain management is increasing in hospitals, largely because it can provide equivalent or better analgesia than conventional nurse-administered opioid analgesia, and patients are more satisfied with its use. There is no decisive pharmacological or clinical argument for the choice of one opioid rather than another. Thus, morphine remains the most frequently used opioid in PCA. The adjunction of non-opioid drugs to morphine in the PCA reservoir is still very controversial. A new investigational PCA transdermal system using iontophoresis to deliver fentanyl seems to provide an adequate pain control with the advantages of needle-free, preprogrammed, self-contained device. Whatever drug or device used, the overall success of the PCA technique relies mainly on the expert supervision of nurses or anesthesiologists in an Acute Pain Service. Indeed, PCA is effective and significant only on the condition that there is careful preoperative patient education and strict postoperative monitoring. In addition, preoperative patient selection allows to exclude patients with evidence of cognitive dysfunction or physical disabilities, making the use of the patient-controlled device impossible. Caution is required among patients with respiratory or renal insufficiency. In the future, the indispensable improvement in the management of postoperative pain should lead to a greater expansion of PCA. However, more pharmaco-economic evaluations will be needed on the cost-effectiveness issue.

show abstract

Section: Pca Versus Conventional Opioid Analgesiamentioning

confidence: 94%

Section: Pca Settingmentioning

confidence: 99%

Section: Pca Versus Conventional Opioid Analgesiamentioning

confidence: 99%

Section: Limitation Of Pcamentioning

confidence: 99%

Section: Limitation Of Pcamentioning

confidence: 99%

See 3 more Smart Citations

Patient-Controlled Analgesia

Mann¹,

Ouro-Bang'na²,

Eledjam

2005

CDT

View full text Add to dashboard Cite

show abstract

Preventable Medical Injuries in Older Patients

Rothschild¹,

Bates²,

Leape³

2000

Arch Intern Med

257

151

View full text Add to dashboard Cite

Injuries associated with hospitalization are more common in older (>/=65 years) than in younger patients (<65 years), and they may be more severe and more often preventable. The increasing age of the population magnifies the importance of this problem. In this review, we first consider medical injuries in general and then review the literature for 6 categories: adverse drug events, falls, nosocomial infections, pressure sores, delirium, and surgical and perioperative complications. For each of these categories, older patients appear to be at higher risk, ranging from a 2.2-fold increase for perioperative complications to a 10-fold increase for falling, based on Harvard Medical Practice Study rates. The main cause of these increased risks appears to be the diminished physiological reserve of elderly patients; however, age alone is a less important predictor of adverse events than comorbidities and functional status. Furthermore, many of these complications appear to be preventable, although the proportion preventable varies by type of complication. While some prevention strategies are specifically beneficial in older patients, many apply to all age groups. Geriatric care units and consultation systems have improved outcomes in some instances, although the data are mixed. The success of intervention varies by type of complications. For medications, various interventions have been successful, and fall prevention programs have been demonstrated to be effective in the nursing home and home.

show abstract

Postoperative Delirium

Ashton²,

1995

View full text Add to dashboard Cite

We conducted an on-line search and manual searches for 1966 through 1992 to determine the incidence, diagnosis, risk factors, and treatment of postoperative delirium. Of the 374 citations found, 277 articles were excluded after criteria of relevance were applied. After methodologic criteria for validity were applied to the remaining 80 articles, 26 studies were retained for the final information synthesis. The incidence of postoperative delirium was 36.8% (range, 0% to 73.5%). Primary reasons for this disparity were insufficient sample size and inconsistent application of numerous diagnostic tools. One study provided statistically significant data that demonstrated that postoperative delirium is underdiagnosed by physicians and nurses. Four of the articles that met the established criteria provided risk factor data. Although age, preoperative cognitive impairment, and the use of anticholinergic drugs were significantly associated with postoperative delirium, gender, type and route of anesthesia, and sleep deprivation were not. Two studies demonstrated a decreased incidence of postoperative delirium when patients underwent preoperative psychiatric counseling or participated in a structured perioperative program. These findings indicate a need for (1) accurate incidence data with further definition of risk factors and (2) studies that address the diagnosis and treatment of this common postoperative problem.

show abstract

Randomized Trial of Postoperative Patient-Controlled Analgesia vs Intramuscular Narcotics in Frail Elderly Men

Cited by 145 publications

References 62 publications

Patient-Controlled Analgesia

Patient-Controlled Analgesia

Preventable Medical Injuries in Older Patients

Postoperative Delirium

Contact Info

Product

Resources

About