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1.
Anaesthesia ; 75(2): 218-226, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31531854

RESUMO

Postoperative nausea and vomiting is the most common side-effect of opioid-based intravenous patient-controlled analgesia. Apfel's simplified risk score is popular but it has some limitations. We developed and validated a dynamic predictive model for nausea or vomiting up to 48 postoperative hours, available as an online web application. Fentanyl was used by 22,144 adult patients for analgesia after non-cardiac surgery under general anaesthesia: we randomly divided them into development (80%) and validation (20%) cohorts, repeated 100 times. We used linear discriminant analysis to select variables for multivariate logistic regression. The incidences of postoperative nausea or vomiting were: 0-48 h, 5691/22,144 (26%); 0-6 h, 2749/22,144 (12%); 6-12 h, 2687/22,144 (12%); 12-18 h, 2624/22,144 (12%); 18-24 h, 1884/22,144 (9%); and 24-48 h, 1082/22,144 (5%). The median (95%CI) area under the receiver operating characteristic curve was 0.72 (0.71-0.73) up to 48 postoperative hours compared with 0.65 (0.64-0.66) for the Apfel model, p < 0.001. The equivalent areas for 0-6 h, 6-12 h, 12-18 h, 18-24 h and 24-48 h were: 0.70 (0.69-0.72); 0.71 (0.69-0.73); 0.69 (0.68-0.71); 0.70 (0.67-0.72); and 0.69 (0.66-0.71), respectively. Our web application allows clinicians to calculate incidences of nausea and vomiting in patients receiving intravenous fentanyl for patient-controlled analgesia.


Assuntos
Analgesia Controlada pelo Paciente/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Fentanila/efeitos adversos , Náusea e Vômito Pós-Operatórios/diagnóstico , Inquéritos e Questionários , Analgésicos Opioides , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enjoo devido ao Movimento/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia
2.
Medicine (Baltimore) ; 98(28): e16403, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305450

RESUMO

BACKGROUND: Thoracic epidural analgesia is the preferred method for postoperative analgesia following thoracic surgery. However, intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. This study was conducted because few scientific reports exist comparing fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment of postoperative pain after video-assisted thoracic surgery (VATS). METHODS: This prospective, and randomized study included 70 patients randomized into fk-IVPCA and t-PCEA groups. Pain at rest and during movement, successful and unsuccessful triggers after pressing the PCA device button, the need for rescue analgesia, drug-related adverse events, and patient satisfaction were recorded for 48 hours postoperatively. RESULTS: No significant differences in the intensity of pain at rest or during movement were observed between the 2 groups within 48 hours postoperatively. The number of unsuccessful PCA triggers in the t-PCEA group 0 to 4 hours after surgery was significantly higher than that in the fk-IVPCA group. However, the numbers of successful PCA triggers in the fk-IVPCA group at 4 to 12 and 0 to 24 hours after surgery were significantly higher than those in the t-PCEA group. The incidence of analgesic-related side effects and patient satisfaction were similar in both groups. CONCLUSIONS: Compared with t-PCEA, the addition of a subanesthetic dose of ketamine to fentanyl-based IVPCA resulted in similar pain control after VATS with no increase in the incidence of drug-related adverse effects. The results confirm that both multimodal intravenous analgesia and epidural analgesia can provide sufficient pain control and are safe strategies for treating acute post-thoracotomy pain.


Assuntos
Analgesia Epidural , Analgesia Controlada pelo Paciente , Analgésicos/administração & dosagem , Fentanila/administração & dosagem , Ketamina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Administração Intravenosa , Analgesia Epidural/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/métodos , Analgésicos/efeitos adversos , Quimioterapia Combinada/efeitos adversos , Feminino , Fentanila/efeitos adversos , Humanos , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Movimento , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Satisfação do Paciente , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento
3.
Ann Surg ; 270(2): 200-208, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31058695

RESUMO

OBJECTIVE: To compare the efficacy and safety of patient-controlled analgesia (PCA) to epidural analgesia in adults undergoing open hepatic resection. BACKGROUND: Effective pain management in patients undergoing open hepatic resection is often achieved with epidural analgesia. However, associated risks have prompted investigation of alternative analgesic methods in this patient population. METHODS: A comprehensive systematic literature review via Medline, Embase, and the Cochrane databases from inception until December 2, 2017 was conducted, followed by meta-analysis. Abstract and full-text screening, data extraction, and quality assessment were conducted by 2 investigators. Odds ratios (OR), mean differences (MD), and 95% confidence intervals were calculated using RevMan 5.3. RESULTS: Four randomized controlled trials with 278 patients were identified. All studies compared the use of PCA to epidural, with differing regimens. Pooled MD and 95% confidence interval for pain score were higher for PCA at rest 24 hours postoperatively (0.59 [0.30, 0.88]), and with movement at 48 hours postoperatively (0.95 [0.31, 1.60]. Pooled MD for hospital length of stay was 1.23 days (-2.72, 5.19). Pooled OR was 0.68 (0.36, 1.3) and 0.24 (0.04, 1.36) for overall and analgesia-related complications, respectively. Need for blood transfusion had a pooled OR of 1.14 (0.31, 4.18). CONCLUSIONS: Epidural analgesia was observed to be superior to PCA for pain control in patients undergoing open hepatic resection, with no significant difference in hospital length of stay, complications, or transfusion requirements. Thus, epidural analgesia should be the preferred method for the management of postoperative pain in this patient population.


Assuntos
Analgesia Epidural , Analgesia Controlada pelo Paciente , Hepatectomia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Transfusão de Sangue , Hematoma Epidural Espinal/etiologia , Humanos , Infusões Intravenosas , Tempo de Internação , Satisfação do Paciente , Complicações Pós-Operatórias
4.
Am J Nurs ; 119(4): 22-27, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30864954

RESUMO

: Background: Intravenous patient-controlled analgesia (IV PCA), which typically involves opioids, has become widely used in clinical settings as an effective method of pain management. Identifying errors in the administration of these drugs is essential to improving patient outcomes. This study sought to describe and analyze the errors associated with postoperative IV PCA. METHODS: Relevant data were collected from the medical records of all patients who received IV PCA at a large academic medical center in South Korea during a three-year period. The study sample comprised 45,104 patients who used one of four types of IV PCA delivery devices. RESULTS: Errors occurred in 406 cases (0.9%). Operator error was the most common type of error (54.7%), followed by device malfunction (32.3%), prescription error (12.3%), and patient error (0.7%). Of the 222 operator errors, the most frequent type was failure to begin IV PCA drug administration (28.8%), followed by programming errors by non-anesthesia providers who weren't authorized to program the device (24.8%) and wrong infusion rates set by anesthesia providers who were so authorized (24.8%). CONCLUSIONS: The findings provide valuable information that can aid in the development of policy and procedures for safer, more effective postoperative administration of IV PCA. They also suggest that it's necessary not only to improve the operation of acute pain services teams, but also to ensure ongoing provider and patient education specific to IV PCA use.


Assuntos
Analgesia Controlada pelo Paciente , Analgésicos Opioides , Bombas de Infusão , Erros de Medicação/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/instrumentação , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Bombas de Infusão/efeitos adversos , Bombas de Infusão/normas , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 98(7): e14538, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762794

RESUMO

To determine efficacy and safety of patient-controlled intravenous analgesia (PCIA) with tramadol and lornoxicam for postoperative analgesia, and its effects on surgical outcomes in patients following thoracotomy.The records of patients who underwent thoracotomy for lung resection between January 2014 and December 2014 at our institution were reviewed. The patients were divided into 2 groups according to postoperative pain treatment modalities. Patients of the patient-controlled epidural analgesia (PCEA) group (n = 63), received PCEA with 0.2% ropivacaine plus 0.5 µg/mL sufentanil, while patients in the PCIA group (n = 48), received PCIA with 5 mg/mL tramadol and 0.4 mg/mL lornoxicam. Data were collected for the quality of pain control, incidences of analgesia related side effects and pulmonary complications, lengths of thoracic intensive care unit stay and postoperative hospital stay, and in-hospital mortality.Pain at rest was always controlled well in both groups during the 4-day postoperative period. Patients in the PCIA group reported significantly higher pain scores on coughing and during mobilization in the first 2 postoperative days. The incidences of side effects and pulmonary complications, in-hospital mortality and other outcomes were similar between groups.PCIA with tramadol and lornoxicam can be considered as a safe and effective alternative with respect to pain control and postoperative outcomes for patients underwent thoracotomy.


Assuntos
Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/métodos , Dor Pós-Operatória/tratamento farmacológico , Toracotomia , Adulto , Fatores Etários , Idoso , Analgesia Epidural/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição da Dor , Piroxicam/administração & dosagem , Piroxicam/efeitos adversos , Piroxicam/análogos & derivados , Complicações Pós-Operatórias/epidemiologia , Testes de Função Respiratória , Ropivacaina/administração & dosagem , Ropivacaina/efeitos adversos , Fatores Sexuais , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos , Tramadol/administração & dosagem , Tramadol/efeitos adversos
6.
BMC Anesthesiol ; 19(1): 26, 2019 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-30797229

RESUMO

BACKGROUND: Standardizing concentrations of intravenous infusions enables pre-preparation and is effective in improving patient safety by avoiding large deviations from the prescribed concentration that can occur when infusions are made individually in wards and theatres. The use of pre-prepared morphine standardized concentration infusions for paediatric nurse/patient-controlled analgesia (N/PCA) has not been previously investigated. We aimed to establish, implement and evaluate standardized concentrations of morphine in pre-filled syringes (PFS) for use in paediatric N/PCA. METHODS: Concentrations of morphine in PFS for N/PCA were identified that accommodated dosage variation across a 1-50 kg weight range. The use of infusions in PFS was implemented and evaluated using mixed methods involved direct observation of healthcare professionals (HCPs), focus groups and failure mode and effects analysis, a HCP survey and medication incident reports analysis. RESULTS: Standardized concentrations, 3 mg, 10 mg and 50 mg morphine in 50 mL sodium chloride 0.9%, delivered prescribed continuous and bolus doses using programmable smart pumps with variable infusion rates. During the implementation, 175 morphine pre-prepared infusions were administered to 157 children (9.4 ± 5.1 years) in theatres and wards. Time taken to set up a N/PCA was 3.7 ± 1.7 min, a reduction of one third compared with the previous system. The number of incidents associated with N/PCA infusions was reduced by 41.2%, and preparation errors were eliminated. HCPs reported using morphine PFS was an easier and safer system. CONCLUSION: A system using pre-prepared standardized concentrations of morphine for paediatric N/PCA was implemented successfully and sustainably.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Erros de Medicação/prevenção & controle , Morfina/administração & dosagem , Adolescente , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Criança , Pré-Escolar , Grupos Focais , Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Humanos , Infusões Intravenosas , Morfina/efeitos adversos , Recursos Humanos de Enfermagem no Hospital , Seringas , Fatores de Tempo
7.
Int J Obstet Anesth ; 39: 12-21, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30685299

RESUMO

BACKGROUND: The RemiPCA SAFE Network was established to set standards and monitor maternal and neonatal outcomes when using remifentanil for labour analgesia. The aim of this analysis was to describe the development of the network standard and to report maternal and neonatal outcome data, including severe adverse events. METHODS: Data sets of the RemiPCA SAFE Network database from the initial six consecutive years (2010-2015) were retrospectively analysed. The data were analysed on an annual basis and set in context with changes of the network standard, i.e. adaptations of the network's standard operating procedure. Main outcomes reported are maternal and neonatal data regarding effectiveness and safety, such as satisfaction, need for bag/mask ventilation and/or cardiopulmonary resuscitation. RESULTS: Among 5740 data sets, no need for maternal ventilation or cardiopulmonary resuscitation was registered. Neonatal cardiopulmonary resuscitations, potentially related to remifentanil, occurred in 0.3%. In parallel with adaptations of the network standard, a moderate rate of maternal hypoxia (oxygen saturation <94% in 24.7%) was found, together with a low rate of supplemental oxygen requirement in neonates (5.0%). CONCLUSION: The RemiPCA SAFE Network data show that remifentanil patient-controlled analgesia can be applied safely. There is bias when data from real clinical settings are analysed retrospectively. Notwithstanding, the approach taken by the RemiPCA SAFE Network, with constant, systematic and standardised evaluation of multiple parameters during the course of labour, might identify trends and anomalies and guide the development and application of safety standards, when translating knowledge from scientific trials into clinical practice.


Assuntos
Analgesia Obstétrica/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Remifentanil/efeitos adversos , Analgesia Epidural , Reanimação Cardiopulmonar , Feminino , Humanos , Recém-Nascido , Auditoria Médica , Satisfação do Paciente , Gravidez , Garantia da Qualidade dos Cuidados de Saúde , Estudos Retrospectivos , Fatores de Tempo
8.
Int J Obstet Anesth ; 39: 22-28, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30509681

RESUMO

BACKGROUND: During labour, remifentanil patient-controlled analgesia is used as an alternative to neuraxial analgesia. Remifentanil is associated with hypoventilation and respiratory depression but the frequency of serious maternal and neonatal adverse events is unknown. The aim of this study was to estimate the number of serious adverse events attributed to the use of remifentanil patient-controlled analgesia during labour in The Netherlands and to investigate the circumstances (e.g. monitoring, practice deviations) of these events and the subsequent management. METHODS: In a nationwide survey among obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was assessed. A questionnaire was sent by email to all 61 Dutch hospitals in which remifentanil patient-controlled analgesia is, or has been, available for labour analgesia. All reported cases were assessed independently by two expert teams. RESULTS: We received information from all hospitals. After independent assessments, 17 cases of single maternal desaturation; 10 maternal cases of apnoea, bradycardia and/or cardiac arrest; and two neonatal cases of respiratory depression, over a period of more than 10 years of remifentanil patient-controlled analgesia use, were identified as a serious adverse event. All serious adverse events were resolved without irreversible damage. CONCLUSIONS: The risk of a potentially life-threatening serious adverse event attributed to remifentanil patient-controlled analgesia seems to be low. All patients recovered without deficit. Adherence to strict monitoring and the attendance of trained healthcare providers is required to safely use remifentanil for labour analgesia.


Assuntos
Analgesia Obstétrica/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Remifentanil/efeitos adversos , Feminino , Humanos , Países Baixos , Gravidez
9.
Arch Gynecol Obstet ; 299(1): 123-128, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30426192

RESUMO

PURPOSE: To compare the pain scores and rates of complications in the labor analgesia process between the two groups. METHODS: There were 127 participants being recruited in this research, and randomly divided into 2 groups according to the anesthetic technique: CSEA with PCEA with EA group (group 1), CSEA with PCEA group (group 2). Group 1 was first operated CSEA and PCEA, then EA at Hegu (LI4), Neiguan (PC6), Zusanli (ST36) and Sanyinjiao (SP6) by HANS-200A device for 25 min. Group 2 was only treated by CSEA and PCEA. The main outcome was the VAS for labor pain. Meanwhile the complications, use of oxytocin, durations of three stages, delivery mode, cord blood pH and neonatus Apgar score in this study were considered as secondary outcomes. RESULTS: After labor analgesia, the VAS scores of group 1 at the five point-in-times were all lower than that of group 2. The rates of fever and urinary retention of group 1 were lower compared with group 2. Group 1 had less usage of oxytocin and shorter durations of cervical dilation from 3 to 10 cm and third stage than group 2. CONCLUSIONS: EA can help to reduce labor pain in CSEA with PCEA labor analgesia process, and may be able to reduce the complications.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Analgesia Controlada pelo Paciente , Anestesia Epidural , Eletroacupuntura/métodos , Dor do Parto/terapia , Trabalho de Parto/efeitos dos fármacos , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Anestesia Epidural/efeitos adversos , Anestésicos , Índice de Apgar , Feminino , Humanos , Ocitocina/administração & dosagem , Medição da Dor , Gravidez , Resultado do Tratamento , Escala Visual Analógica
10.
J Surg Res ; 233: 100-103, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502234

RESUMO

BACKGROUND: In some institutions, urinary catheters (UCs) have been placed in all patients receiving opioid patient-controlled analgesia (PCA) because of the increased incidence of urinary retention. Our institutional data demonstrated no UC replacements in 48 children who had PCA for perforated appendicitis who had their catheters removed before discontinuation of the PCA. As part of a quality improvement initiative, we discontinued the practice of requiring UC with PCA for perforated appendicitis. MATERIALS AND METHODS: A prospective list of patients with perforated appendicitis was maintained. Data were gathered regarding 60 consecutive patients. UC placement was allowed for specific indications including urinary retention and surgeon discretion. RESULTS: Sixteen patients (27%) received a UC with 14 of these being placed in the operating room (OR). Two UCs were placed outside the OR for urinary retention. Patients who underwent UC placement in the OR weighed significantly more than those who did not (33 versus 42 kg, P = 0.05). No patients required replacement of the catheter once removed. There were no postoperative urinary tract infections. Median PCA duration was 68 h (50, 98) for patients with UC placed in the OR compared with 60 h (47, 78) (P = 0.42). Median postoperative length of stay for patients with UC placed in the OR was 95 h (76, 140) compared with 90 h (70, 113) (P = 0.09). CONCLUSIONS: UC can be withheld from patients with perforated appendicitis who are placed on PCA with a very low placement rate. UC placement at time of operation did not lengthen time receiving PCA or length of stay.


Assuntos
Analgesia Controlada pelo Paciente/efeitos adversos , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Retenção Urinária/prevenção & controle , Adolescente , Analgésicos Opioides/administração & dosagem , Cateteres de Demora/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Dor Pós-Operatória/etiologia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/normas , Cateteres Urinários/efeitos adversos , Retenção Urinária/etiologia
11.
Support Care Cancer ; 27(1): 33-42, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30056529

RESUMO

CONTEXT: Opioids administered by various routes are a mainstay of tumour-related pain management. Subcutaneous or intravenous patient-controlled analgesia (PCA) with opioids is an appropriate and safe form of treatment for postoperative pain but studies on this form of administration are sparse in the setting of cancer pain despite widespread use. OBJECTIVE: To evaluate the published studies on opioids administered by subcutaneous and intravenous patient-controlled analgesia for patients with cancer pain. METHODS: Articles were identified from the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 7, 2016), PubMed (Medline; 1975 to 2016) and EMBASE (1974 to 2016). Additional reports were identified from the reference lists of retrieved papers. Studies based on original data with a focus on intravenous or subcutaneous PCA administration of opioids in patients suffering from cancer-related pain were selected. The language was restricted to Dutch, English or German. Predefined information was extracted depending on the topic. RESULTS: Fifty studies published since 1980 met the inclusion criteria. A wide range of study designs, study quality and research objectives were observed. The studies indicated use of standard or by proxy PCA in the inpatient and outpatient setting were safe and useful while significant adverse effects were rarely observed. CONCLUSION: This systematic review of the current evidence suggests PCA can be appropriately used in a wide range of clinical situations.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Dor do Câncer/tratamento farmacológico , Administração Intravenosa , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Humanos , Injeções Subcutâneas , Neoplasias/tratamento farmacológico , Neoplasias/cirurgia , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico
12.
Int J Colorectal Dis ; 34(1): 27-38, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30519843

RESUMO

PURPOSE: A meta-analysis of RCTs was designed to provide an up-to-date comparison of thoracic epidural analgesia (TEA) and patient-controlled analgesia (PCA) in laparoscopic colectomy. METHODS: Our study was completed following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature screening was performed in MEDLINE and Web of Science. Fixed effects (FE) or random effects (RE) models were estimated based on the Cochran Q test result. RESULTS: Totally, 8 studies were introduced in the present meta-analysis. Superiority of PCA in terms of length of hospital stay (LOS) (WMD 0.73, p = 0.004) and total complication rate (OR 1.57, p = 0.02) was found. TEA had a lower resting pain visual analogue scale (VAS) score at Day 1 (WMD - 2.23, p = 0.005) and Day 2 (WMD - 2.17, p = 0.01). TEA group had also a systematically lower walking VAS. Moreover, first bowel opened time (first defecation) (WMD - 0.88, p < 0.00001) was higher when PCA was applied. CONCLUSIONS: TEA was related to a lower first bowel opened time, walking, and resting pain levels at the first postoperative days. However, the overall complication rate and LOS were higher in the epidural analgesia group. Thus, for a safe conclusion to be drawn, further randomized controlled trials (RCTs) of a higher methodological and quality level are required.


Assuntos
Analgesia Epidural , Analgesia Controlada pelo Paciente , Colectomia , Laparoscopia , Vértebras Torácicas/efeitos dos fármacos , Idoso , Analgesia Epidural/efeitos adversos , Analgesia Controlada pelo Paciente/efeitos adversos , Colectomia/efeitos adversos , Determinação de Ponto Final , Feminino , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição da Dor , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Viés de Publicação
13.
J Perianesth Nurs ; 33(6): 865-879, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30449435

RESUMO

PURPOSE: Intravenous (IV) opioids are administered for management of acute postoperative pain in the postanesthesia care unit. The benefits of parenteral oxycodone for acute pain management are understudied. The purpose of this review was to evaluate the effectiveness of IV oxycodone for acute postoperative pain. DESIGN: A systematic review of quantitative studies using the Joanna Briggs Institute approach. METHODS: A search for randomized controlled trials was conducted, revealing 314 potentially relevant studies. These were compared with the inclusion criteria. Those that met these criteria were critically appraised. FINDINGS: Participants (N = 506) in eight trials were included in this review. Four studies supported the use of IV oxycodone as patient-controlled analgesia and IV bolus. The remaining studies showed equipotent effects between oxycodone and control. Higher incidences of adverse effects were associated with IV oxycodone. CONCLUSIONS: IV oxycodone can be considered as effective analgesia for acute postoperative pain with careful regards to its adverse effects.


Assuntos
Analgésicos Opioides/administração & dosagem , Oxicodona/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Dor Aguda/tratamento farmacológico , Administração Intravenosa , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/efeitos adversos , Humanos , Oxicodona/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
J Perianesth Nurs ; 33(5): 741-745, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30236582

RESUMO

PURPOSE: In this study, we aim to investigate the relationship between patient-controlled analgesia (PCA) and the incidence of pressure ulcer in postcesarean section mothers. DESIGN: A retrospective analysis was performed among consecutive cesarean section mothers in 2016. METHODS: Univariate and multivariate logistic regression was used to analyze the relationship between PCA and postcesarean section pressure ulcers. FINDINGS: One thousand nine hundred eighteen cesarean section mothers were included in the study. Forty-five mothers (2.3%; 95% confidence interval [CI], 1.7%-3.1%) developed stage I pressure ulcer. The pressure ulcers were cured in 2 to 5 days. Eighty percent (1,535) of mothers received PCA after cesarean section surgery. Pressure ulcer incidence was significantly higher in the PCA group compared with non-PCA groups (2.9% vs 0.0%, Fisher's exact P < .0001). Patient-controlled intravenous analgesia and patient-controlled epidural analgesia showed the same pressure ulcer risk (3.2% vs 2.6%, χ2 = 0.581, P = .446). After multivariate analysis by logistic regression, the adjusted odds ratio of PCA for pressure ulcer risk was 33.632, with a 95% CI of 25.061 to 45.134. CONCLUSIONS: Our results showed PCA was an independent risk factor for pressure ulcer in postcesarean section mothers. Although the pressure ulcers were all rated as stage I and can be cured in 2 to 5 days, we still recommended some pressure ulcer prevention strategy should be used for these mothers.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Cesárea , Complicações Pós-Operatórias/epidemiologia , Lesão por Pressão/epidemiologia , Adulto , Analgesia Controlada pelo Paciente/efeitos adversos , Feminino , Humanos , Incidência , Complicações Pós-Operatórias/patologia , Gravidez , Lesão por Pressão/etiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Cochrane Database Syst Rev ; 8: CD010434, 2018 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-30161292

RESUMO

BACKGROUND: Intravenous patient-controlled analgesia (IVPCA) with opioids and epidural analgesia (EA) using either continuous epidural administration (CEA) or patient-controlled (PCEA) techniques are popular approaches for analgesia following intra-abdominal surgery. Despite several attempts to compare the risks and benefits, the optimal form of analgesia for these procedures remains the subject of debate. OBJECTIVES: The objective of this review was to update and expand a previously published Cochrane Review on IVPCA versus CEA for pain after intra-abdominal surgery with the addition of the comparator PCEA. We have compared both forms of EA to IVPCA. Where appropriate we have performed subgroup analysis for CEA versus PCEA. SEARCH METHODS: We searched the following electronic databases for relevant studies: Cochrane Central Register of Controlled Trials (CENTRAL) (2017; Issue 8), MEDLINE (OvidSP) (1966 to September 2017), and Embase (OvidSP) (1988 to September 2017) using a combination of MeSH and text words. We searched the following trial registries: Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, and the EU Clinical Trials Register in September 2017, together with reference checking and citation searching to identify additional studies.We included only randomized controlled trials and used no language restrictions. SELECTION CRITERIA: We included all parallel and cross-over randomized controlled trials (RCTs) comparing CEA or PCEA (or both) with IVPCA for postoperative pain relief in adults following intra-abdominal surgery. DATA COLLECTION AND ANALYSIS: Two review authors (JS and EY) independently identified studies for eligibility and performed data extraction using a data extraction form. In cases of disagreement (three occasions) a third review author (MB) was consulted. We appraised each included study to assess the risk of bias as outlined in Section 8.5 of the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE to assess the quality of the evidence. MAIN RESULTS: We included 32 studies (1716 participants) in our review. There are 10 studies awaiting classification and one ongoing study. A total of 869 participants (51%) received EA and 847 (49%) received IVPCA. The EA trials included 16 trials with CEA (418 participants) and 16 trials with PCEA (451 participants). The studies included a broad range of surgical procedures (including hysterectomies, radical prostatectomies, Caesarean sections, colorectal and upper gastrointestinal procedures), a wide range of adult ages, and were performed in several different countries.Our pooled analyses suggested a benefit with regard to pain scores (using a visual analogue scale between 0 and 100) in favour of EA techniques at rest. The mean pain reduction at rest from waking to six hours after operation was 5.7 points (95% confidence interval (CI) 1.9 to 9.5; 7 trials, 384 participants; moderate-quality evidence). From seven to 24 hours, the mean pain reduction was 9.0 points (95% CI 4.6 to 13.4; 11 trials, 558 participants; moderate-quality evidence). From 24 hours the mean pain reduction was 5.1 points (95% CI 0.9 to 9.4; 7 trials, 393 participants; moderate-quality evidence). Due to high statistical heterogeneity, no pooled analysis was possible for the estimation of pain on movement at any time. Two single studies (one using CEA and one PCEA) reported lower pain scores with EA compared to IVPCA at 0 to 6 hours and 7 to 24 hours. At > 24 hours the results from 2 studies (both CEA) were conflicting.We found no difference in mortality between EA and IVPCA, although the only deaths reported were in the EA group (5/287, 1.7%). The risk ratio (RR) of death with EA compared to using IVPCA was 3.37 (95% CI 0.72 to 15.88; 9 trials, 560 participants; low-quality evidence).A single study suggested that the use of EA may result in fewer episodes of respiratory depression, with an RR of 0.47 (95% CI 0.04 to 5.69; 1 trial; low-quality evidence). The successful placement of an epidural catheter can be technically challenging. The improvements in pain scores above were accompanied by an increase in the risk of failure of the analgesic technique with EA (RR 2.48, 95% CI 1.13 to 5.45; 10 trials, 678 participants; moderate-quality evidence); the occurrence of pruritus (RR 2.36, 95% CI 1.67 to 3.35; 8 trials, 492 participants; moderate-quality evidence); and episodes of hypotension requiring intervention (RR 7.13, 95% CI 2.87 to 17.75; 6 trials, 479 participants; moderate-quality evidence). There was no clear evidence of an advantage of one technique over another for other adverse effects considered in this review (Venous thromboembolism with EA (RR 0.32, 95% CI 0.03 to 2.95; 2 trials, 101 participants; low-quality evidence); nausea and vomiting (RR 0.94, 95% CI 0.69 to 1.27; 10 trials, 645 participants; moderate-quality evidence); sedation requiring intervention (RR 0.87, 95% CI 0.40 to 1.87; 4 trials, 223 participants; moderate-quality evidence); or episodes of desaturation to less than 90% (RR 1.29, 95% CI 0.71 to 2.37; 5 trials, 328 participants; moderate-quality evidence)). AUTHORS' CONCLUSIONS: The additional pain reduction at rest associated with the use of EA rather than IVPCA is modest and unlikely to be clinically important. Single-trial estimates provide low-quality evidence that there may be an additional reduction in pain on movement, which is clinically important. Any improvement needs to be interpreted with the understanding that the use of EA is also associated with an increased chance of failure to successfully institute analgesia, and an increased likelihood of episodes of hypotension requiring intervention and pruritus. We have rated the evidence as of moderate quality given study limitations in most of the contributing studies. Further large RCTs are required to determine the ideal analgesic technique. The 10 studies awaiting classification may alter the conclusions of the review once assessed.


Assuntos
Analgesia Epidural , Analgesia Controlada pelo Paciente , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Epidural/mortalidade , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/mortalidade , Analgésicos Opioides/uso terapêutico , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Zhonghua Zhong Liu Za Zhi ; 40(8): 626-630, 2018 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-30139035

RESUMO

Objective: To evaluate the safety and efficiency of patient-controlled intravenous analgesia (PCIA) using hydromorphone supplement with dexmedetomidine on patients undergoing transcatheter arterial chemoembolization. Methods: One hundred and eighty patients, age ranged from 40 to 65 years, body mass index from 18 to 25 kg/m(2,) ASA physical status Ⅱ-Ⅲ, who were scheduled for transcatheter arterial chemoembolization (TACE) under monitor anesthesia care (MAC) were randomly divided into 3 groups: hydromorphone group (H group), hydromorphone supplement with dexmedetomidine 1 µg/kg group (D1 group), hydromorphone supplement with dexmedetomidine 2 µg/kg group (D2 group), 60 patients in every group. All the groups of patients received PCIA pump, in the H group, the PCIA reagent was composed of 120 µg/kg hydromorphone and 5 mg tropisetron in 100 ml of normal saline. In comparison, PCIA regiment was composed of 120 µg/kg hydromorphone, 1 µg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D1 group, while 120 µg/kg hydromorphone, 2 µg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D2 group. The visual analogue scale (VAS) score, the observer's assessment of alertness/sedation scale (OAA/S) score, patients' satisfaction index, consumption of hydromorphone, the additional dose of morphine, the effective pressing times of PCIA and adverse reactions were recorded in detail at 0, 0.5, 1, 4, 12 and 24 hours after the patients underwent TACE. Results: The total consumptions of hydromorphone were (4.3±0.1), (4.1±0.1), and (3.8±0.1) mg in group H, D1, and D2, respectively, and the effective pressing times were 13±3, 6±2 and 2±1, the additional doses of morphine were (30±5), (15±3), and (3±1) mg, and adverse reaction rates were 45.0%, 28.3%, and 10.0%, respectively. The manifestations mentioned above in D2 group were significantly lower than those in group H and group D1 (P<0.05). Immediately and 5 min after embolization, at the end of surgery and 0.5, 1, 4, 12 and 24 h after surgery, the VAS scores in the D2 group were 1.9±0.2, 2.1±0.3, 1.8±0.4, 1.8±0.3, 1.7±0.3, 1.6±0.3, 1.3±0.2, 1.3±0.3, respectively, lower than those in group H and group D1 (P<0.05); The satisfaction index in D2 group at these times were 8.7±1.1, 8.9±0.8, 9.2±0.9, 9.0±0.7, 9.1±0.8, 9.0±0.6, 9.1±0.7, 9.2±0.9, respectively, higher than those in group H and group D1 (P<0.05). No breath depression happened in these three groups. Conclusion: The formula of hydromorphone combined with dexmedetomidine to patients undergoing TACE is greatly safe and efficient, with advantages in alleviating pain, reducing hydromorphone consumption and the incidence of adverse reaction of hydromorphone, and without breath depression.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Quimioembolização Terapêutica/métodos , Dexmedetomidina/administração & dosagem , Hidromorfona/administração & dosagem , Administração Intravenosa , Adulto , Idoso , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos Opioides/efeitos adversos , Artérias , Quimioembolização Terapêutica/efeitos adversos , Dexmedetomidina/efeitos adversos , Quimioterapia Combinada , Humanos , Hidromorfona/efeitos adversos , Indóis/administração & dosagem , Pessoa de Meia-Idade , Tropizetrona
17.
Sci Rep ; 8(1): 9952, 2018 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-29967332

RESUMO

This study evaluated the efficacy and safety of dexmedetomidine in intravenous patient-controlled analgesia (PCA) after cesarean delivery. This multicenter study enrolled 208 subjects who were scheduled for selective cesarean delivery from 9 research centers. Patients received 0.5 ug/kg dexmedetomidine (study group) or normal saline (control group) after delivery and an intravenous PCA pump after surgery (100 µg sufentanil +300 µg dexmedetomidine for the study group, 100 µg sufentanil for the control group, background infusion: 1 ml/h, bolus dose: 2 ml and lock time: 8 min). The sufentanil consumption, pain scores, rescue analgesia, sedation scores, analgesic satisfaction, the incidence of postoperative nausea and vomiting (PONV) and the first passage of flatus were recorded within 24 h after surgery. The sufentanil consumption in the study group was significantly lower than that in the control group (p = 0.004). Compared with the control group, the study group had lower pain scores (p < 0.01), higher analgesic satisfaction degree [p < 0.001, odd ratio 4.28 and 95% CI (2.46, 7.46)], less requirement of rescue analgesia (p = 0.003), lower incidence of PONV (p = 0.005 and p < 0.001, respectively), and shorter time to first passage of flatus (p = 0.007). Dexmedetomidine added to sufentanil intravenous PCA significantly enhanced the analgesic effects, improved analgesic satisfaction, and had the potential benefits of reducing PONV and the recovery of intestinal functions after cesarean section.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Cesárea/efeitos adversos , Dexmedetomidina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Sufentanil/administração & dosagem , Administração Intravenosa , Adulto , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos não Entorpecentes/efeitos adversos , Dexmedetomidina/efeitos adversos , Feminino , Humanos , Náusea/induzido quimicamente , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Gravidez , Estudos Prospectivos , Sufentanil/efeitos adversos , Resultado do Tratamento , Vômito/induzido quimicamente
18.
PLoS One ; 13(6): e0199930, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29953514

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common adverse effect of opioid-based intravenous patient-controlled analgesia (IV PCA). Nefopam has been considered as a good candidate for inclusion in multimodal analgesia because of its opioid sparing effect, but it can be emetic. This study aims to examine whether the use of nefopam combined with fentanyl in IV PCA was associated with the higher incidence of PONV in patients receiving prophylactic ramosetron after gynecological surgery. METHODS: Data from 296 patients who underwent gynecological surgery were retrospectively reviewed. The patients received IV PCA containing either fentanyl 1500 µg and ketorolac 90 mg (Group K) or fentanyl 1500 µg and nefopam 80 mg (Group N). All patients in both groups received 0.3 mg of ramosetron at the end of surgery. The primary outcome measure was the incidence of PONV during the 3-day postoperative period. RESULTS: No difference was observed in the incidence of PONV during the 3-day postoperative period between the two groups. However, the incidence of nausea on postoperative day 2 was significantly higher in Group N (10.3%) than in Group K (2.8%) (P = 0.016). Multivariable logistic regression analysis showed that the use of nefopam was not associated with a higher incidence of PONV (adjusted odds ratio, 1.616; 95% confidence interval, 0.952-2.743, P = 0.076). There were no differences in postoperative pain scores between the two groups. CONCLUSION: The combined use of nefopam with fentanyl in IV PCA was not associated with the higher incidence of PONV compared with the use of ketorolac and fentanyl combination in patients who received ramosetron as PONV prophylactic agent. However, prospective trials are required for a confirmative conclusion.


Assuntos
Analgesia Controlada pelo Paciente , Anestesia Obstétrica , Benzimidazóis/administração & dosagem , Procedimentos Cirúrgicos em Ginecologia , Nefopam/efeitos adversos , Náusea e Vômito Pós-Operatórios , Adulto , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Feminino , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Humanos , Incidência , Pessoa de Meia-Idade , Nefopam/administração & dosagem , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estudos Retrospectivos
19.
Transplant Proc ; 50(5): 1365-1371, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29880358

RESUMO

BACKGROUND: Sympathetic blockade associated with epidural analgesia was reported to be a risk factor for acute kidney injury (AKI) following liver resection. The purpose of this study was to compare the incidence of AKI after living-donor hepatectomies according to the type of patient-controlled analgesia (PCA). METHODS: A total of 316 patients after living-donor hepatectomy were retrospectively analyzed; 148 patients in the epidural PCA group and 168 patients in the intravenous (IV) PCA group were evaluated. AKI was defined as an increase in serum creatinine ≥0.3 mg/dL, ie, 1.5-fold from the baseline, or a reduction in the urine output in the first 48 hours after surgery, based on the Acute Kidney Injury Network criteria. Logistic regression analysis was performed to identify the independent risk factors for AKI after living-donor hepatectomy. RESULTS: Baseline characteristics were similar between the 2 groups except the age. Volumes of fluids and colloids administered intraoperatively were greater in the epidural PCA group (P < .001 and P = .006, respectively). The incidence of AKI did not show significant differences between the 2 groups (8.1% vs 7.1%; P = .747). In multivariate analysis, preoperative serum alanine transaminase level ≥50 U/L was identified as a risk factor for postoperative AKI. However, epidural PCA failed to be a risk factor for postoperative AKI. CONCLUSIONS: The type of PCA did not affect the incidence of postoperative AKI after living-donor hepatectomy. Despite significant differences in the postoperative hemodynamics, the incidence of AKI was similar between 2 groups.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Analgesia Controlada pelo Paciente/efeitos adversos , Analgesia Controlada pelo Paciente/métodos , Hepatectomia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Idoso , Analgesia Epidural/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Incidência , Infusões Intravenosas , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodos
20.
PLoS One ; 13(5): e0196388, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29758039

RESUMO

BACKGROUND: The preemptive multimodal pain protocols used in total knee arthroplasty (TKA) often cause emesis postoperatively. We investigated whether palonosetron prophylaxis reduces postoperative nausea and vomiting (PONV) in high-risk patients after TKA. METHODS: We randomized 120 female patients undergoing TKA to receive either palonosetron (0.075 mg, intravenous) or no antiemetic prophylaxis (0.9% saline, control group). All patients were given spinal anesthesia, a continuous femoral nerve block, and fentanyl-based intravenous patient controlled analgesia. Patients undergoing staged bilateral TKA were assigned to one group for the first knee and the other group for the second knee. The overall incidence of PONV, the incidences of both nausea and vomiting, severity of nausea, complete response, requirement for rescue antiemetics, pain level, opioid consumption, and satisfaction scores were evaluated during three periods: 0-2, 2-24, and 24-48 h postoperatively. We also compared PONV and pain between the first and second TKA. RESULTS: The incidence of PONV during the first 48 h was lower in the palonosetron group compared with the controls (22 vs. 41%, p = 0.028), especially 2-24 h after surgery, as was the nausea and vomiting respectively. The severity of nausea was lower in the palonosetron group (p = 0.010). The complete response rate (93 vs. 73%, p = 0.016) and satisfaction score (84 ± 12 vs. 79 ± 15, p = 0.032) were higher in the palonosetron group during 2-24 h after surgery. Patients who underwent a second operation complained of more severe pain, and consumed more opioids than those of the first operation. There was no difference in the incidence of PONV between the first and second operations. CONCLUSIONS: Palonosetron prophylaxis reduced the incidence and severity of PONV in high-risk patients managed with multimodal pain protocol for 48 h, notably 2-24 h after TKA.


Assuntos
Antieméticos/farmacologia , Artroplastia do Joelho/efeitos adversos , Isoquinolinas/farmacologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Quinuclidinas/farmacologia , Idoso , Idoso de 80 Anos ou mais , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Antieméticos/administração & dosagem , Método Duplo-Cego , Feminino , Fentanila/efeitos adversos , Humanos , Isoquinolinas/administração & dosagem , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/fisiopatologia , Palonossetrom , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Estudos Prospectivos , Quinuclidinas/administração & dosagem , Fatores de Risco
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