Staff time requirements for postoperative pain management: Comparison of sufentanil sublingual tablet system and intravenous patient-controlled analgesia.

OBJECTIVE: Assessment and allocation of required staff time for postoperative pain management for two different pa-tient-controlled technologies, sufentanil sublingual tablet system (SSTS) and intravenous analgesia (PCiA). DESIGN: Activity-based evaluation. SETTING: The study was conducted at four German hospitals based on the availability of the two technologies studied and their respective bed capacity broadly reflecting the German hospital landscape. PATIENTS AND PARTICIPANTS: Staff activities were recorded for 162 SSTS and 154 PCiA procedures. Every hospital recorded around 40 procedures for each technology between December 2016 and July 2017. INTERVENTIONS: Staff time was recorded if a patient received one of the two considered postoperative pain management technologies and was under treatment of a trained nurse. No further criteria were defined. Documentation of resource utilization covered all staff activities concerning the two technologies by detailed activity recording forms. MAIN OUTCOME MEASURE(S): Staff time for five identified process areas (preparation of therapy option, provisioning at patients' bed, therapy, removal of therapy option, reprocessing, and storage) with significant impact on the entire process. RESULTS: The average staff time required for SSTS to manage the entire process was 36 minutes whereas for PCiA it was 49 minutes (p < 0.0001). In all process areas, SSTS showed significantly less staff time requirements. CONCLUSIONS: In comparison to PCiA, SSTS requires significantly less staff time to manage postoperative pain in the studied setting.

[Patient-controlled Analgesia (PCA): an Overview About Methods, Handling and New Modalities]. / Patientenkontrollierte Analgesie: Methoden, Handhabung und Ausbaufähigkeit.

Patient-controlled analgesia (PCA) is one of the well established methods for the treatment of postoperative pain. A cochrane-review concluded that PCA is associated with better postoperative pain ratings and improved patient-satifaction compared to traditional way of administering opioids. Some prerequisites concerning patient selection, education of the patient and the medical staff, and supervision during PCA therapy are mandatory for a safe use of PCA. Current PCA modalities (intravenous and epidural routes of application) are expanded by newer, less invasive routes of drug administration, e.g. by the iontophoretic transdermal and the sublingual route. Their role in improving safety and the quality of pain therapy on the one hand side, and costs on the other hand side are discussion.

Activity-based cost analysis of opioid-related nausea and vomiting among inpatients.

OBJECTIVE: Nausea and/or vomiting (N/V) are frequent side effects of opioid drugs. These are of major concerns to patients and caregivers and only few studies have focused on their economical costs. DESIGN: This is a prospective, nonproduct-related, activity-based evaluation of personnel and material costs of opioid-related N/V among inpatients. SETTING: Data were obtained from surgical, general medicine, and palliative care wards at 16 German hospitals of different size, healthcare mandate, and ownership. PATIENTS, PARTICIPANTS: According to predefined criteria, of 462 documented N/V events, 340 were diagnosed as opioid related. INTERVENTIONS: Elicited activities and pharmacological interventions for N/V episodes followed local standards. MAIN OUTCOME MEASURE: Both materials used and the time engaged to treat patients with N/V were documented on an "ad hoc" activity recording form. The total cost of an opioid-related N/V episode was calculated based on standard wages of the involved personnel and standard costs of the inherent materials used. RESULTS: Mean staff tenure time for handling an episode of N/V was 26.2 ± 19.8 minutes (nausea 16.9 ± 28.7 minutes; nausea + vomiting: 33.4 ± 26.8 minutes). In the German context, this corresponds to average personnel costs of €18.06 ± 13.64. Material cost contributes to another €13.49 ±13.38 of costs mainly depending on acquisition costs of antiemetic drugs. CONCLUSIONS: N/V showed to have impact on workload of nurses and (to lesser extent) physicians and economic burden of €31 ± 22 for each N/V episode. In view of these results, the potential costs of strategies to minimize the incidence of N/V (use of antiemetics and/or the use of new analgesics) should be outweighed against the incurred costs of N/V.

Feasibility and precision of subcutaneous continuous glucose monitoring in patients undergoing CABG surgery.

OBJECTIVES: To evaluate if subcutaneous continuous glucose monitoring (sCGM) is feasible in cardiac surgery and if reliable glucose values are reported under hypothermic extracorporeal circulation. DESIGN: Feasibility trial. SETTING: University hospital. PARTICIPANTS: Ten consecutive patients undergoing coronary artery bypass grafting. INTERVENTIONS: Prior to surgery, during hypothermic extracorporeal bypass, and 48 hours postoperatively, arterial blood glucose samples were compared with sCGM every 30 minutes. Statistical analysis utilized Clarke's error grid and Bland-Altman plot. MEASUREMENTS AND MAIN RESULTS: Three hundred fifty-one pairs of glucose measurements were recorded including 59 during hypothermic extracorporeal circulation. Agreement between these measurements was acceptable, with a regression line slope of 0.88 and an offset of 17.4 (p = 0.87). Error grid analysis indicated a safe margin of 99.1% within zone A (no clinical action needed) or zone B (values would not lead to inappropriate treatment). Only 0.9% were plotted in zone D (potentially dangerous failure). Measurements during hypothermic extracorporeal circulation were comparable. Correlation coefficient was 0.760. The offset regression line was more pronounced (50.9) with a flatter slope (0.640). Within the error grid all plot values were in zone A or B. CONCLUSIONS: sCGM compared with arterial blood gas glucose monitoring under hypothermic extracorporeal circulation appears to be feasible and reliable.