The effectiveness of patient control analgesia in the treatment of acute traumatic pain in the emergency department

Rahman, Nik Hisamuddin Nik Ab; DeSilva, Terence

doi:10.1097/mej.0b013e32834bfc17

Cited by 15 publications

(18 citation statements)

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“…Additionally, a meta-analysis done on the same group showed that patients preferred PCADs significantly more than standard therapy [8]. Studies which have been conducted that have evaluated patient satisfaction for patients presenting to the emergency room have also shown similar results, with the overwhelming majority of studies showing a clear preference for PCADs [9,11,33,[41][42][43][44][45][46]. This is likely due to several factors including faster time to analgesia, decreased need of nursing assistance and an increased sense of autonomy and control over one's pain [44].…”

Section: Patient Autonomy and Patient Satisfactionmentioning

confidence: 92%

“…Five out of the eight studies in question have shown statistically significant results which favor PCAD use over conventional intravenous therapy. Two of the remaining studies demonstrated a downward trend which favored PCADs (although this did not reach the threshold for statistical significance) and only one study showed no difference [9,11,33,[41][42][43][44][45][46]. Unfortunately there is…”

Section: Pain Reductionmentioning

confidence: 95%

“…It is imperative that physicians maximize their ability to take care of patients in an empathetic manner which utilizes principles of patient autonomy and shared decision making. Studies have demonstrated that PCADs are preferred by many patients in comparison with both IV and IM preparations and patient satisfaction with this type of treatment is generally high [5,9,11,33,[41][42][43][44][45][46]. In a recent systematic review of 21 trials which included 1260 postoperative patients, it was shown that patients had increased satisfaction with PCAD use in all of the studies that were included in the cohort [8].…”

Section: Patient Autonomy and Patient Satisfactionmentioning

confidence: 99%

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The Utility of Patient-Controlled Analgesia for Managing Acute Pain in the Emergency Department

Bender¹,

Papa²

2019

From Conventional to Innovative Approaches for Pain Treatment

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There is a growing expectation of physicians to treat acute pain more aggressively in the emergency department (ED). This has contributed to an increase in opiate prescribing practices that has resulted in a crisis of medication abuse and misuse. The resultant backlash against physicians has created a void within the realm of acute pain management, as physicians search for a means to treat their patients in a way that is both empathetic and responsible. In an effort to combat this growing epidemic, alternative means of pain control are being explored. Patientcontrolled analgesia devices (PCADs) have been used extensively in multiple fields of medicine and have demonstrated significant clinical utility for treating pain postoperatively; however there is a dearth of evidence to support their use within the acute care setting. Due to this lack of evidence, PCADs have not been widely implemented in the ED. Recent studies have shown that the use of PCADs may improve objective pain scores and increase both patient and nurse satisfaction while reducing the likelihood of developing chronic pain. The economic feasibility of this undertaking remains unclear; however there is strong evidence for the clinical utility of this modality to treat acute pain in this population.

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Section: Patient Autonomy and Patient Satisfactionmentioning

confidence: 92%

Section: Pain Reductionmentioning

confidence: 95%

Section: Patient Autonomy and Patient Satisfactionmentioning

confidence: 99%

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The Utility of Patient-Controlled Analgesia for Managing Acute Pain in the Emergency Department

Bender¹,

Papa²

2019

From Conventional to Innovative Approaches for Pain Treatment

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“…PCA is commonly used for acute postoperative pain, but it can also be used for the management of other types of acute pain such as in the hospital emergency department 33 . It has been documented that acute pain is not controlled adequately in the emergency care setting 34,35 . This observation of suboptimal pain management may extend to situations in which the patient requires transfer between hospitals (usually for a higher level of care) in emergency vehicles 36,37 .…”

Section: Patient-controlled Analgesia: Backgroundmentioning

confidence: 99%

Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting

Morlion

Schäfer

Betteridge

et al. 2018

Current Medical Research and Opinion

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Evidence-based guidelines for acute postoperative pain management support the use of multimodal regimens in many situations. As effective and safe alternatives to conventional PCA, and with the added benefits of being non-invasive, easy to use and allowing early patient mobilization, the newer PCA systems may complement multimodal approaches, or potentially replace certain regimens, in hospitalized patients with acute postoperative pain.

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“…A smaller study from Malaysia included patients presenting with pain of traumatic origin;19 96 patients in two centres were randomised to either standard care or PCA (1 mg boluses), with a significant reduction reported in pain scores in the PCA group compared to the standard care group. The same two authors reported another smaller study of 47 patients with traumatic injury 20. Patients were again randomised to receive either standard care or PCA (1 mg boluses).…”

Section: Introductionmentioning

confidence: 99%

PAin SoluTions In the Emergency Setting (PASTIES); a protocol for two open-label randomised trials of patient-controlled analgesia (PCA) versus routine care in the emergency department

et al. 2013

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IntroductionPain is the commonest reason that patients present to an emergency department (ED), but it is often not treated effectively. Patient controlled analgesia (PCA) is used in other hospital settings but there is little evidence to support its use in emergency patients. We describe two randomised trials aiming to compare PCA to nurse titrated analgesia (routine care) in adult patients who present to the ED requiring intravenous opioid analgesia for the treatment of moderate to severe pain and are subsequently admitted to hospital.Methods and analysisTwo prospective multi-centre open-label randomised trials of PCA versus routine care in emergency department patients who require intravenous opioid analgesia followed by admission to hospital; one trial involving patients with traumatic musculoskeletal injuries and the second involving patients with non-traumatic abdominal pain. In each trial, 200 participants will be randomised to receive either routine care or PCA, and followed for the first 12 h of their hospital stay. The primary outcome measure is hourly pain score recorded by the participant using a visual analogue scale (VAS) over the 12 h study period, with the primary statistical analyses based on the area under the curve of these pain scores. Secondary outcomes include total opioid use, side effects, time spent asleep, patient satisfaction, length of hospital stay and incremental cost effectiveness ratio.Ethics and disseminationThe study is approved by the South Central—Southampton A Research Ethics Committee (REC reference 11/SC/0151). Data collection will be completed by August 2013, with statistical analyses starting after all final data queries are resolved. Dissemination plans include presentations at local, national and international scientific meetings held by relevant Colleges and societies. Publications should be ready for submission during 2014. A lay summary of the results will be available to study participants on request, and disseminated via a publically accessible website.Registration detailsThe study is registered with the European Clinical Trials Database (EudraCT Number: 2011-000194-31) and is on the ISCRTN register (ISRCTN25343280).

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The effectiveness of patient control analgesia in the treatment of acute traumatic pain in the emergency department

Abstract: PCA provides more effective pain relief and patient satisfaction when compared with the conventional method of bolus intravenous injection for the relief of traumatic pain in the emergency department setting.

Cited by 15 publications

References 0 publications

The Utility of Patient-Controlled Analgesia for Managing Acute Pain in the Emergency Department

The Utility of Patient-Controlled Analgesia for Managing Acute Pain in the Emergency Department

Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting

PAin SoluTions In the Emergency Setting (PASTIES); a protocol for two open-label randomised trials of patient-controlled analgesia (PCA) versus routine care in the emergency department

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