Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair - a randomized controlled trial.

BACKGROUND: Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery. Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital. To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane (ESP) block or combined ESP and pectoralis nerve (PECS) blocks. METHODS: This was a prospective, randomized, controlled, double-blinded study done in a tertiary hospital. Thirty patients undergoing mitral/tricuspid valve repair via mini-thoracotomy were included. Patients were randomly allocated to one of two groups: ESP or PECS + ESP group (1:1 randomization). Patients in both groups received a single-shot, ultrasound-guided ESP block. Participants in PECS + ESP group received additional PECS blocks. Each patient had to be extubated within 2 h from the end of the surgery. Pain was treated via a patient-controlled analgesia (PCA) pump. The primary outcome was the total oxycodone consumption via PCA during the first postoperative day. The secondary outcomes included pain intensity measured on the visual analog scale (VAS), patient satisfaction, Prince Henry Hospital Pain Score (PHHPS), and spirometry. RESULTS: Patients in the PECS + ESP group used significantly less oxycodone than those in the ESP group: median 12 [interquartile range (IQR): 6-16] mg vs. 20 [IQR: 18-29] mg (p = 0.0004). Moreover, pain intensity was significantly lower in the PECS + ESP group at each of the five measurements during the first postoperative day. Patients in the PECS + ESP group were more satisfied with pain management. No difference was noticed between both groups in PHHPS and spirometry. CONCLUSIONS: The addition of PECS blocks to ESP reduced consumption of oxycodone via PCA, reduced pain intensity on the VAS, and increased patient satisfaction with pain management in patients undergoing mitral/tricuspid valve repair via mini-thoracotomy. TRIAL REGISTRATION: The study was registered on the 19th July 2018 (first posted) on the ClinicalTrials.gov identifier: NCT03592485.

Postoperative Pain in Patients Undergoing Cancer Surgery and Intravenous Patient-Controlled Analgesia Use: The First and Second 24 h Experiences.

INTRODUCTION: Postoperative cancer pain imposes severe physical and psychological problems. We aimed to investigate the pain experiences of patients with cancer after surgery, analyze the impact of infusion volume by patient-controlled analgesia (PCA), and explore the variations between day 1 and day 2. METHODS: Data were retrospectively extracted from a large health data platform. Descriptive statistics were presented for the demographic and clinical profiles of patients. Multiple logistic regression analyses were performed to evaluate associations between intensity of pain and PCA use after adjustment for risk factors. RESULTS: Among 11,383 patients with cancer, the incidence of pain (moderate to severe pain) was 93.3% (18.3%) at the first 24 h after operation, while the respect values decreased to 91.1% and 9.5% at the second 24 h. Further, female patients consistently experienced higher risk of pain over the whole 48 h postoperatively. Surgical sites were related to pain risk, with the highest risk among the respiratory system (OR 2.077, 95% CI 1.392-3.100). High doses of continuous volume (OR 2.453, 95% CI 1.742-3.456) and total volume (OR 2.830, 95% CI 2.037-3.934) of infusions were related to 1-3-fold elevated pain risk. Additionally, the observed associations were mostly repeated and could be up to over 10 times when pain was evaluated with number of PCA pump compressions instead of Numerical Rating Scale (NRS). CONCLUSIONS: High risk of postoperative cancer pain, particularly among the high PCA dose group, could possibly indicate inadequate pain control, and presence of modifiable risk factors warrants more aggressive pain management strategies perioperatively.

Awareness of general nurses in management of postoperative pain through patient controlled analgesia - Comparison among the Czech Republic and the Kingdom of Saudi Arabia.

Background: Postoperative pain management is one of the largest worldwide challenges faced by healthcare professionals and is one of the most common problems that accompany patients in the postoperative period. Objectives: We evaluated the awareness of general nurses on the management of postoperative pain through PCA (patient-controlled analgesia) on a multicultural level among general nurses from the Czech Republic (CZ) and the Kingdom of Saudi Arabia (KSA). Materials and Methods: A cross-sectional study was performed by the distribution of the questionnaires. We distributed 403 questionnaires in CZ and 550 questionnaires in KSA. Statistical analysis was performed by program STATA15 at the significance level ∝ =0.05. Results: The study included total of 833 respondents (N = 360 CZ; N = 473 KSA). In both countries, the majority of the respondents were female (CZ 89, 7%; KSA 92, 4%). The average age was similar in both countries (38.6 years in CZ and 35.6 years in KSA). We found out that the use of the treatment through PCA differs between both countries according to the type of department (P < 0.05). We verified that the frequency of use of the PCA method differs in the post-anesthesia care unit between CZ and KSA (P = 0.000). Conclusions: According to the available results, we can state that the general nurses in KSA care for patients with the PCA much more often and have more experience with the PCA than general nurses from CZ.

Group-based trajectory analysis of acute pain after spine surgery and risk factors for rebound pain.

Background: This retrospective study was designed to explore the types of postoperative pain trajectories and their associated factors after spine surgery. Materials and methods: This study was conducted in a single medical center, and patients undergoing spine surgery with intravenous patient-controlled analgesia (IVPCA) for postoperative pain control between 2016 and 2018 were included in the analysis. Maximal pain scores were recorded daily in the first postoperative week, and group-based trajectory analysis was used to classify the variations in pain intensity over time and investigate predictors of rebound pain after the end of IVPCA. The relationships between the postoperative pain trajectories and the amount of morphine consumption or length of hospital stay (LOS) after surgery were also evaluated. Results: A total of 3761 pain scores among 547 patients were included in the analyses and two major patterns of postoperative pain trajectories were identified: Group 1 with mild pain trajectory (87.39%) and Group 2 with rebound pain trajectory (12.61%). The identified risk factors of the rebound pain trajectory were age less than 65 years (odds ratio [OR]: 1.89; 95% CI: 1.12-3.20), female sex (OR: 2.28; 95% CI: 1.24-4.19), and moderate to severe pain noted immediately after surgery (OR: 3.44; 95% CI: 1.65-7.15). Group 2 also tended to have more morphine consumption (p < 0.001) and a longer length of hospital stay (p < 0.001) than Group 1. Conclusion: The group-based trajectory analysis of postoperative pain provides insight into the patterns of pain resolution and helps to identify unusual courses. More aggressive pain management should be considered in patients with a higher risk for rebound pain after the end of IVPCA for spine surgery.

Intravenous patient-controlled analgesia does not increase the risk of postoperative delirium compared to patient-controlled epidural analgesia: a propensity score-matched retrospective cohort study.

BACKGROUND: It is unclear whether the doses of opioids and the routes of administration used for postoperative analgesic management are associated with delirium. We aimed to compare the incidence of postoperative delirium (POD) between intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) in patients who underwent postoperative analgesic management using opioids. METHODS: We retrospectively investigated surgical patients (n=3,324) who received patient-controlled analgesia (PCA). Morphine was used for IVPCA, and fentanyl and ropivacaine were used for PCEA. The patients' background characteristics, perioperative management, presence of POD, and postoperative analgesia technique after IVPCA (n=1,184) or PCEA (n=2,140) were assessed. We divided the patients into IVPCA and PCEA groups and compared the incidence of POD by propensity score matching. We used the independent t-test for comparisons between the groups, and P<0.05 as considered as statistically significant. RESULTS: POD was noted in a total of 125 patients (3.8%); 55 patients (4.6%) with IVPCA and 70 patients (3.3%) with PCEA (P=0.046). There was no statistically significant difference in cumulative opioid usage up to postoperative day 2 (in mg) between patients with and without POD (POD 62.7±39.8 vs. non-POD 48.9±50.3, P=0.10). After propensity score matching, 1,156 patients with similar baseline characteristics were selected. POD was noted in 22 of 578 patients (3.8%) in the IVPCA group and 30 of 578 patients (5.2%) in the PCEA group, with no difference between the two groups (P=0.256). On the other hand, opioid usage was higher in the IVPCA group than in the PCEA group (P<0.001). CONCLUSIONS: There was no difference in the incidence of POD between morphine IVPCA and fentanyl PCEA when the patient characteristics were matched using propensity score matching. POD occurs regardless of the route and dose of opioid administration.

Postoperative analgesia in patients undergoing robot-assisted thoracic surgery: a comparison between thoracic epidural analgesia and intercostal nerve block combined with intravenous patient-controlled analgesia.

BACKGROUND: Recently, robot-assisted thoracic surgery (RATS) is increasingly applied to lung or mediastinal tumor surgery. However, appropriate methods of postoperative analgesia for RATS have not been studied. METHODS: Patients who underwent RATS at a single university hospital between January, 2017 and March, 2018 were studied retrospectively. Patients were anesthetized with either general anesthesia alone or combined general and thoracic epidural anesthesia. Accordingly, postoperative analgesia was managed with either intravenous patient-controlled analgesia (PCA) with fentanyl or thoracic epidural analgesia (TEA) with morphine and levobupivacaine. Patients were thus divided into 2 groups (PCA and TEA) according to methods of postoperative analgesia, and analgesic efficacies were compared between the groups with regard to pain scores evaluated on a 11-point numerical rating scale (NRS) at 0, 3, 6, 12, 18, 24, and 48 h postoperatively, rescue analgesic requirements within 24 h, side effects of anesthesia and analgesia, including respiratory depression, hypotension, nausea, pruritus, and urinary retention, time to ambulation after surgery, and hospital stay after surgery. RESULTS: Data from 107 patients (76 in Group PCA and 31 in Group TEA) were analyzed. NRS pain scores at 6, 18, and 48 h were significantly less or tended to be less in Group TEA than in Group PCA (1.8±2.0 vs. 2.6±1.8, P=0.045; 1.7±1.5 vs. 2.4±1.8, P=0.047; and 1.9±1.4 vs. 2.5±1.6, P=0.063, respectively). The number of patients who required rescue analgesics within 24 h was significantly less in Group TEA than in Group PCA [4/31 (12%) vs. 32/76 (42%), P=0.004]. The other parameters were not significantly different between the groups. CONCLUSIONS: Compared with PCA, TEA provided better analgesia after RATS in terms of less pain scores, less rescue analgesic requirements, and similar side effect profiles. TEA with a hydrophilic opioid and local anesthetic seemed an appropriate method of postoperative analgesia in patients undergoing RATS.

Intercostal cryoablation during Nuss procedure: A large volume single surgeon's experience and outcomes.

BACKGROUND: Recent studies have shown intercostal cryoablation(IC) during the Nuss procedure decreases hospital length of stay(LOS) and opioid administration. However, few studies have also evaluated the risk of postoperative complications related to IC. METHODS: We performed a single center retrospective analysis of all patients who underwent Nuss procedure by one surgeon from 2/2016 to 2/2020, comparing intraoperative IC to other pain management modalities(non-IC). Primary outcomes were postoperative complications, hospital LOS, and opioid administration. Multivariate analysis was performed with outcomes reported as regression coefficients(RC) or odds ratios(OR) with 95% confidence interval. RESULTS: IC was associated with decreased hospital LOS (RC -1.91[-2.29 to -1.54], less hospital opioid administration (RC -4.28[-5.13 to -3.43]), and less discharge opioid administration (RC -3.82[-5.23 to -2.41]). With respect to postoperative complications, IC decreased the odds of urinary retention (OR 0.16[0.06 to 0.44]); however, increased the odds of slipped bars requiring reoperation (OR 36.65[5.04-266.39]). CONCLUSIONS: Our single surgeon experience controls for surgeon variability and demonstrates intraoperative IC for the Nuss procedure is an effective pain management modality that decreases hospital LOS and opioid use during hospitalization and at discharge; however, it is associated with increased odds of slipped bars requiring reoperation. LEVEL OF EVIDENCE: III.

Postoperative sufentanil intravenous patient-controlled analgesia within the first 24 hours: a retrospective study.

BACKGROUND: Intravenous patient-controlled analgesia (IV-PCA) is recommended for postoperative systemic analgesia by the American Pain Society. As there is no efficacy advantage and a higher probability of adverse events, routine basal infusion of opioids is not recommended for opioid-naïve adults. However, the opioids referred to in postoperative pain management guidelines were mainly morphine. Nowadays, sufentanil is widely used in postoperative acute pain management. In this retrospective study, we evaluated and compared the analgesic effect, PCA use, as well as adverse events among different basal infusions with sufentanil-based postoperative PCA. METHODS: The data of 322 eligible postoperative patients who received sufentanil-based IV-PCA from January 2018 to December 2019 were collected in this study. According to the settings of background infusions, patients were allocated to 3 groups: 2, 1, or 0.5 mL/hour. The primary endpoint was PCA attempts and successful delivery. We also evaluated the occurrence of adverse events associated with sufentanil-based PCA and the intensity of postoperative pain using the Numeric Rating Scale (NRS). RESULTS: PCA attempts, successful deliveries, total volume of PCA and patient NRS scores were significantly different between the 3 groups (P<0.05). Through pairwise comparison, there was only a statistical difference between the 2 mL/hour and the 0.5 mL/hour group in PCA attempts, successful deliveries, and total volumes of PCA. There were no statistical differences in adverse events between groups (P>0.05). CONCLUSIONS: We found that a smaller background infusion with sufentanil required more bolus infusions and a higher total volume of PCA within 24 hours after surgery. However, NRS scores were higher in the smaller background infusion group. Our results highlight the need for further studies to optimize doses for sufentanil IV-PCA basal infusions, which will also provide useful information to enhance the quality of pain control in the future.

Sufentanil Sublingual for Acute Post-Operative Pain: A Systematic Literature Review Focused on Pain Intensity, Adverse Events, and Patient Satisfaction.

CONTEXT: Pain is commonly experienced among patients after surgical procedures. Clinical pain management after surgery is far from being successful. Patients may control postoperative pain by self-administration of intravenous opioids using devices designed for this purpose (patient-controlled analgesia or PCA). PCA devices have been developed including the sufentanil sublingual tablet system (SSTS). A systematic review of the use of SSTS for postoperative pain is needed to identify an alternative method of pain management. OBJECTIVES: To systematically review literature to establish the efficacy and the safety of PCA with SSTS used in the treatment of moderate-to-severe acute post-operative pain in a hospital setting. METHODS: Embase, MEDLINE, Google Scholar, and Cochrane Central Trials Register were systematically searched in December 2019 for studies examining SSTS for pain in adult after surgical procedures. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively. RESULTS: Sixteen studies evaluating SSTS were included for a total of 2311 patients. All participants in the SSTS group reported NRS ≤ 4 within 24 h after surgery. Patient satisfaction was high, with a minimum of 70% satisfaction among patients treated with SSTS. The most common adverse events (AEs) overall for SSTS 15 and 30 mcg were nausea, vomiting, and headache. AEs observed in the studies were generally consistent with those associated with opioids and the postsurgical setting. CONCLUSIONS: SSTS is an important system for the management of moderate-to-severe acute pain in a hospital setting. SSTS is well tolerated, with no unexpected adverse events (AEs) and no clinically meaningful vital sign changes. These data confirm the safety and tolerability of the SSTS. Successful pain management resulted in a high level of acceptance of the SSTS by patients with high satisfaction for the method of pain control.

Benefit of subcutaneous patient controlled analgesia after total knee arthroplasty.

PURPOSE: Subcutaneous patient-controlled analgesia (PCA) has been widely used for orthopedic surgeries including total knee arthroplasty (TKA). This study aims to clarify the usefulness of subcutaneous PCA in the early phase after TKA. METHODS: Our subjects consisted of 88 osteoarthritis knee patients who underwent primary TKA, and were classified into two groups: 42 patients received a subcutaneous PCA (containing fentanyl and droleptan) after operation (PCA group), and 46 patients were managed without a subcutaneous PCA (control group). We compared the incidence of side effects for 3 days postoperatively, measuring the number of times patients used adjuvant analgesia and range of motion on day 7 between the two groups. 34 of 42 patients in the PCA group tolerated PCA use until POD 3 (continuation sub-group), while 8 patients could not continue PCA (interruption sub-group). Demographic data of the two sub-groups were compared. RESULTS: The mean number of times adjunctive analgesics were used by the PCA group (3.7 ±â€¯2.2) was significantly less than in the control group (5.4 ±â€¯2.8) (p = 0.0049). There were no significant differences in the frequency of side effects between the two groups. There was no significant difference in range of motion between the two groups. Comparing the continuation and interruption sub-groups, patients over 80 years old were at risk to discontinue a subcutaneous PCA (p = 0.0319, odds ratio 5.4). CONCLUSION: These findings demonstrate that subcutaneous PCA would be a safe postoperative pain regimen for TKA patients, but the effect was not enough to promote early functional recovery. LEVELS OF EVIDENCE: Therapeutic, Level Ⅱ.

Comparison of different methods of postoperative analgesia after thoracotomy-a randomized controlled trial.

BACKGROUND: Continuous thoracic epidural analgesia (TEA) is a preferred method of postoperative analgesia in thoracic surgery. Intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. One of the most commonly used opioids in PCA is morphine. It has high antinociceptive efficacy but is associated with many adverse events. Oxycodone can be an alternative. A small number of scientific reports comparing morphine and oxycodone in PCA for the treatment of acute postoperative pain after thoracotomy was the reason to conduct this study. METHODS: Prospective, randomised, observational study. In total of 99 patients scheduled for elective thoracotomy were randomized into three study groups. TEA group received continuous TEA as a method of postoperative pain management, morphine (MF) group received morphine IVPCA, and morphine (OXY) group oxycodone IVPCA. For 48 hours' hemodynamic parameters, level of pain, sedation and the need for rescue analgesia were monitored. After 48 hours' patients were asked about their satisfaction with pain treatment using Likert scale and assessment of opioid related adverse events via overall benefit of analgesia score (OBAS). RESULTS: The level of pain in visual analogic score (VAS) and Prince Henry Hospital Pain Score (PHHPS) scales was significantly lower in TEA group with no significant difference between groups MF and OXY. Using morphine in PCA was associated with a significantly higher likelihood of need of rescue analgesia. The level of sedation in Ramsay scale was significantly higher in MF compared to OXY and TEA group. There were no significant differences between groups in OBAS scale. TEA group was characterized by the highest degree of patient satisfaction. CONCLUSIONS: TEA provided superior anaesthesia compared to PCA in our study group. Use of PCA oxycodone in postoperative pain management after open thoracotomy provides similar nociception control compared to morphine but is associated with less sedation and patients using oxycodone IVPCA require smaller doses of rescue analgesia compared to systemic morphine IVPCA.

Comparison of Parenteral Opioid Dosing in Adult Sickle Cell Disease Patients With Vaso-occlusive Crisis.

Sickle cell disease (SCD) is a chronic condition characterized by multiple vaso-occlusive complications, including acute pain crisis. The mainstay of treatment for patients presenting with vaso-occlusive crisis (VOC) is pain control and adequate hydration. Currently, there are no studies to determine an optimal pain control regimen in adult SCD patients. The main objective of this study is to evaluate whether outcomes differ in patients with VOC based on pain management treatment modality. A retrospective review of admissions with a primary diagnosis of VOC admitted to our facility was conducted. The primary outcome was to compare the average length of stay (LOS) in patients treated with intermittent injection (INT) or patient-controlled analgesia (PCA). Secondary outcomes assessed included 30-day readmission, treatment failure, and impact on pain scores. Of 302 admissions screened, 150 met inclusion criteria (INT: n = 100; PCA: n = 50). Selection of initial pain control regimen showed no difference in average LOS (INT: 5.96 ± 4.19 days vs. PCA: 6.01 ± 3.47 days; P = .94) or 30-day readmission rates (INT: 21% vs. PCA: 16%; P = .52). Treatment failure was significantly higher in the INT group, occurring in 64% of patients vs. 14% in the PCA group (P < .0001). Pain scores were not significantly impacted by selection of pain regimen. Our study indicates that INT and PCA treatment modalities are both effective at controlling pain in VOC; however, more patients in the INT group were characterized as having a treatment failure. Based on our results, it is reasonable to initiate PCA as the primary pain treatment strategy in SCD patients presenting in VOC.

Impacto del uso de analgesia peridural controlada por la paciente en la disminución del dolor durante el trabajo de parto en un hospital del suroccidente colombiano / Impact of the use of patient-controlled epidural analgesia on pain reduction during labor in a hospital in southwestern colombia

Introducción: La analgesia epidural controlada por la paciente (PCA) provee flexibilidad al permitir acomodar la analgesia de acuerdo con las necesidades crecientes del dolor a medida que progresa el trabajo de parto (TP). El propósito de este estudio es objetivar el impacto en el alivio del dolor y satisfacción materna en pacientes en TP con analgesia PCA.Pacientes y métodos: Estudio descriptivo prospectivo realizado en el segundo semestre del 2020. Se incluyeron gestantes con embarazo único con escala verbal numérica (EVN) mayor a 3 y se excluyeron a las pacientes con contraindicaciones para inserción de catéter. Posterior a la inserción, se valoró el dolor y se entregó un cuestionario para calificar el dolor a los 15 min y en el expulsivo.Resultados: La población estaba constituida por mujeres jóvenes, el 72 % con embarazo a término. El catéter peridural se insertó en la fase latente del trabajo de parto en el 53,4 % de los casos. Al momento de la inserción del catéter, la mediana de dolor fue de 8 (6-10), a los 15 minutos 2 (0-4) y en el expulsivo 5 (3-8). El 75 % de las maternas refirieron estar muy satisfechas y el 19 % satisfechas; un 3 % indicaron estar poco satisfechas y el 1 % restante, insatisfechas. La prevalencia náusea y vómito fue del 16 % y 15 %, respectivamente.Conclusiones: PCA como estrategia analgésica durante el trabajo de parto a través de bolos intermitentes a demanda logró un adecuado control del dolor en los primeros minutos posterior a la inserción sin un control óptimo durante el expulsivo, sin embargo, se obtuvo una satisfacción materna global alta.(AU)

Introduction: Patient-controlled analgesia (PCA) allows patients to accommodate analgesia according to increasing pain needs as labor progresses. This study aims to objectify the impact on pain relief and maternal satisfaction in labor patients with PCA analgesia.Patients and methods: A prospective descriptive study was carried out in the second semester of 2020. Pregnant women with a singleton pregnancy with a numerical rating scale (NRS) greater than three were included, and patients with contraindications for catheter insertion were excluded. After insertion, pain was assessed, and a questionnaire was given to rate pain at 15 min and during expulsion.Results: The population consisted of young women, 72 % of whom were pregnant at term. The epidural catheter was inserted in the latent phase of labor in 53.4 % of cases. At the time of catheter insertion, the median pain was 8 (6-10), at 15 minutes 2 (0-4), and expulsion 5 (3-8). Seventy-five percent of the mothers reported being very satisfied and 19 % satisfied; 3 % reported being slightly satisfied, and the remaining 1 % dissatisfied. The prevalence of nausea and vomiting was 16 % and 15 %, respectively.Conclusions: PCA as an analgesic strategy during labor through intermittent boluses on-demand achieved adequate pain control in the first minutes after insertion without optimal control during expulsion. However, high overall maternal satisfaction was obtained.(AU)

Patient satisfaction about using patient controlled analgesia in managing pain post surgical intervention.

Management of postoperative pain using patient controlled analgesia (PCA) has increased for its proven advantages over conventional methods of pain control. The purpose of this study was to investigate patients' satisfaction about using PCA post surgical intervention among patients at Saudi health care settings. A cross-sectional, descriptive correlational design was used to collect data from patients using PCA post surgical interventions. The analysis showed that patients had a moderate to high level of perception about efficacy of PCA, and had a moderate level of knowledge about PCA use and its function. The duration of using a PCA pump, patients' age, gender, marital status, educational level, type of surgery, and their work status were significant predictors (F 7, 76 = 5.13, p < .001; R(2) = 0.59). PCA offers patients with an individualized analgesic therapy that meets the patients' demand of pain control. The implications for nurses and medical staff are discussed.

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.

Operative anesthesia and pain control.

A comprehensive understanding of operative anesthesia and postoperative pain control is essential to the practicing colon and rectal surgeon. Most of the operations performed-particularly in the perineum-cause significant patient discomfort and often result in a lengthy recovery period. A variety of factors, including patient positioning in the operating room and patient expectations, influence the choice of operative anesthesia. Postoperatively numerous modalities and agents exist for pain control. With this variety of options at hand, surgeons should be educated and decisions should be individualized, with the ultimate goals of improving the patient experience and facilitating recovery.

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