Structured Education Programme on Patient Controlled Analgesia (PCA) for Orthopaedic Patients

Patient-controlled analgesia (PCA) via an infusion pump enables patient to administer their own analgesia. The aim of this study was to evaluate the effect of an educational programme in managing post-operative pain and satisfaction on PCA following orthopedic surgery. A pre-test and post-test interventional study design with implementation of patient education programme on PCA was provided to 54 respondents. The control group received conventional PCA briefing from the Acute Pain Service protocol. Pain intensity was measured at 2 hrs, 6 hrs and 24 hrs following surgery and pre-test and post-test of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was administered. There was difference in respondents’ level of pain score among the study respondents’ medians for control group at 2 hrs, 6 hrs and 24 hrs following surgery and they were 7.00 (IQR=3.00), 5.00 (IQR=2.00) and 3.00 (IQR=2.00); intervention group at 2 hrs, 6 hrs and 24 hrs following surgery were 6.00 (IQR=2.00), 3.00 (IQR=1.00) and 1.00 (IQR=1.00) respectively. There were significant differences in median of pain score between intervention and control group at 2 (U=142.0, p<0.05), 6 (U=150.50, p<0.05) and 24 (U=120.00, p<0.05) hrs following surgery. There were statistically significant differences (p<0.05) in the median of patient’s pain severity at all pain levels i.e. least pain, worst pain, and severe pain between intervention and control group (least pain, U=219.50, p<0.05; worst pain, U=117.0, p<0.05; severe pain, U=49.0, p<0.05). In conclusion, patients who received pre-operative structured education programme showed improvement in managing post-operative pain and satisfaction on PCA after orthopedic surgery.

Antiemetic Effect of Midazolam added to Patient-Controlled Analgesia after Total Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Midazolam has been reported to decrease postoperative nausea and vomiting (PONV). We studied the antiemetic effect of midazolam in patients receiving intravenous patient-controlled analgesia (PCA) using morphine after total abdominal hysterectomy. METHODS: Group C (n = 27) received bolus of morphine 5 mg and PCA of morphine 1 mg/ml. Group M1 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.2 mg/ml mixed with morphine 1 mg/ml. Group M2 (n = 27) received bolus of morphine 5 mg and midazolam 1 mg and PCA of midazolam 0.4 mg/ml mixed with morphine 1 mg/ml. The PCA delivery system was programmed to deliver 1 ml of the test solution per demand with a 10 min lockout interval and no background infusion. The incidence of PONV, metoclopramide and ketorolac usage, morphine and midazolam consumption, pain, sedation, and other side effects were assessed at 1, 4, 8, 16, 24, 36 and 48 h after the operation. RESULTS: The incidences of PONV were 19 (70%) in Group C, 14 (52%) in Group M1 and 10 (37%) in Group M2. The incidence of PONV in Group M2 was significantly lower than that in Group C (P < 0.05). Patients in Group M2 experienced more sedation than those in Group C (P < 0.05). No severe sedation was observed in all groups. CONCLUSIONS: Combination of midazolam 0.4 mg per morphine 1 mg in PCA had more effective antiemetic efficacy than control without significant adverse effects.

A comparison of patient-controlled analgesia (PCA) and intramuscular analgesia after orthognathic surgery

Patient-controlled analgesia (PCA) has been widely used for postoperative pain control in medical surgery parts. Conventional intramuscular analgesia (IMA) is also effective in postoperative pain control, but it has some disadvantages that depend on patients'perception of pain and the anxiety that they endure caused by the delay of the injection time. This study was conducted to assess the efficacy and postoperative outcomes of intravenous PCA compared to IMA injections in 36 patients (BSSRO). Three factors were compared: amount of pain in PCA and IMA group ; amount of pain according to the sex in PCA and IMA group and the amount of pain according to the analgesia use. Results of this study did not demonstrate a statistically significant difference in any of these, using a p value of 0.05. The results of this study were as follows: 1. There was no statistically significant difference in VAS pain score between IMA group and PCA group. 2. There was no statistically significant difference according to the sex. 3. There was no statistically significant difference according to the amount of PCA. The history of PCA is about 30 years and many literatures have reported about its effects, complications, methods, advantages and disadvantages. So, this study has some limitations of small sample size to conclude the effects of PCA. But when the decision about the method for postoperative pain control has to be made, it should be made based on patient or physician preference and cost factors rather than on the trend.

A clinical study on the effectiveness of patient-controlled analgesia(PCA) after orthognathic surgery