scholarly journals The Scientific Basis of Patient-Controlled Analgesia

1988 ◽  
Vol 16 (4) ◽  
pp. 427-436 ◽  
Author(s):  
L. E. Mather ◽  
H. Owen
Keyword(s):  
A Priori ◽  
Animal Experiments ◽  
Therapeutic Index ◽  
Scientific Basis ◽  
Patient Controlled Analgesia ◽  
Background Infusion ◽  
Drug Choice ◽  
Infusion Method ◽  
Lockout Interval ◽  
Post Hoc

The current practice of patient-controlled analgesia has grown from empirical observations. Although several variants of patient-controlled analgesia, bolus doses, infusions, or combinations of both, have been suggested, a scientific basis for advocating one variant over the others has been lacking. Most systems have been based on the simplest system, bolus demand, although the use of a combined bolus and background infusion method has theoretical merit. Similarly, a scientific basis for setting the variables of patient-controlled analgesia, drug choice, incremental dose, maximum dose and lockout interval, also has been lacking. Settings for these variables may be rationalised post hoc on the basis of the physicochemical properties and global pharmacokinetic properties of the opioids used but knowledge of these properties has not helped in setting the variables a priori. Foremost, the drug choice should be based on therapeutic index. Knowledge of the regional kinetics of drug (influx and efflux) from brain may provide a more logical basis for setting the patient-controlled analgesia variables but such information can only come from animal experiments. More research is required if patient-controlled analgesia is to become anything but an empirical tool in the quest for improved analgesia in patients.

scholarly journals Perbandingan Efektivitas Patient-Controlled Analgesia (PCA) Fentanil, PCA Morfin dan Tramadol Intravena Sebagai Analgetik Pasca Operasi Modified Radical Mastectomy (MRM)

2018 ◽  
Vol 10 (2) ◽  
pp. 74
Author(s):  
Arie Faishal Madjan ◽  
Widya Istanto Nurcahyo
Keyword(s):  
Radical Mastectomy ◽  
Loading Dose ◽  
Modified Radical Mastectomy ◽  
Patient Controlled Analgesia ◽  
Background Infusion ◽  
Lockout Interval ◽  
One Way Anova

Latar Belakang: Operasi Modified Radical Mastectomy menimbulkan nyeri derajat sedang hingga berat pasca operasi. Sebagian pasien yang mendapat kombinasi anagetik tramadol dan ketorolak secara berkala, masih mengeluh nyeri. PCA merupakan metode baru pemberian analgetik. Penggunaan PCA fentanil dan PCA morfin diharapkan dapat lebih efektif dalam mengatasi nyeri pasca operasi MRM.Tujuan: Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas, efek samping dan tingkat kepuasan pasien antara penggunaan PCA fentanil, PCA morfin dan tramadol intravena sebagai analgetik pasca operasi MRM.Metode:Dilakukan uji klinis tersamar ganda terhadap 36 pasien rencana operasi MRM yang memenuhi kriteria penelitian. Setelah dilakukan anestesi umum, pasien dibagi dalam 3 kelompok perlakuan pemberian analgetik pasca operasi: (1) kelompok PCA fentanil dengan fentanil loading dose 50 mcg, demand dose 20 mcg, lockout interval 10 menit, limitdose 70 mcg/jam, background infusion 30 mcg/jam; (2) kelompok PCA morfin dengan morfin loading dose 4 mg, demand dose 1 mg, lockout interval 10 menit, limit dose 6 mg/jam, tanpa background infusion; (3)kelompok tramadol yang mendapat tramadol intravena 100 mg/8jam. Dilakukan penilaian berkala skor NRS, RASS, tanda vital, efek samping dan tingkat kepuasan pasien selama 24 jam pasca operasi. Data dianalisa dengan Shapiro-Wilk dilanjutkan Kruskal-Wallis atau One way ANOVA, dianggap bermakna bila p< 0,05.Hasil:Efektivitas terbaik pada PCA fentanil, diikuti PCA morfin lalu tramadol. Skor RASS PCA fentanil dan PCA morfin lebih rendah dari tramadol (p=0,000). Terdapat efek samping mual, muntah dan dizziness yang secara statistik tidak berbeda bermakna. Tingkat kepuasan pasien tertinggi pada kelompok PCA fentanil, sedangkan antara kelompok PCA morfin dan tramadol tidak berbeda bermakna(p=0,009).Simpulan: PCA fentanil dan PCA morfin lebih efektif dibandingkan tramadol. PCA fentanil memberikan tingkat kepuasan pasien yang lebih tinggi dibanding PCA morfin dan tramadol. Terdapat efek samping mual, muntah dan dizziness namun secara statistik tidak berbeda bermakna.

scholarly journals Cutoff Values for Providing the Ideal Intravenous Patient-Controlled Analgesia According to the Intensity of Postoperative Pain—A Retrospective Observational Study

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1065
Author(s):  
Keum Young So ◽  
Sang Hun Kim
Keyword(s):  
Postoperative Pain ◽  
Opioid Analgesic ◽  
Patient Controlled Analgesia ◽  
Bolus Volume ◽  
Analgesic Requirement ◽  
Cutoff Values ◽  
Background Infusion ◽  
Lockout Interval ◽  
Numeric Rating ◽  
The Ideal

Background and Objectives: The cutoff values were analyzed for providing the ideal intravenous patient-controlled analgesia (PCA) that could reduce rescue analgesics or antiemetics requirements, based on the grades of postoperative pain intensity (PPI). Materials and Methods: PCA regimens of 4106 patients were retrospectively analyzed, and they were allocated into three groups with low, moderate, and high PPI grades (groups L, M, and H, respectively) based on numeric rating scores obtained 6 h postoperatively. Opioid and non-opioid analgesic doses were converted into fentanyl-equivalent doses (DOSE-FEN-OP and DOSE-FEN-NONOP, respectively). The primary endpoint was the cutoff values of these parameters. Results: With respect to the PCA settings to reduce rescue analgesic and antiemetic requirements, group L required a background infusion rate (BIR) of 1.75–3 mL/h, bolus volume of 0.5–1.25 mL, and lockout interval of ≤12.5 min. Group M required a BIR of 1.75 mL/h, bolus volume of 0.5–1.75 mL, and lockout interval of ≤5 min. Group H required a BIR of 1.75 mL/h, bolus volume of 0.5 mL, and lockout interval of ≤5 min. In assessments of the analgesic doses to reduce rescue analgesic requirement, the DOSE-FEN-OP was at least 950 μg of fentanyl regardless of group, while the DOSE-FEN-NONOP was ≥250 μg, ≥550 μg, and ≥700 μg for the L, M, and H groups, respectively. In assessments of the analgesic doses to reduce rescue antiemetic requirement, DOSE-FEN-OP was ≤950 μg for groups L and M and ≤850 μg for Group H, while DOSE-FEN-NONOP was ≤50 μg, ≤450 μg, and ≤700 μg for groups L, M, and H, respectively. Conclusion: The ideal PCA for reduction in rescue analgesics or antiemetics can be achieved by adjustment of PCA settings and drug dosages carefully with these cutoff values depending on the expected grades of PPI. Especially, the ideal PCA can be provided by adjusting the lockout interval and bolus volume rather than BIR and by applying smaller bolus doses and shorter lockout intervals with an increasing PPI grade.

scholarly journals When Does HARKing Hurt? Identifying When Different Types of Undisclosed Post Hoc Hypothesizing Harm Scientific Progress

2017 ◽  
Vol 21 (4) ◽  
pp. 308-320 ◽  
Author(s):  
Mark Rubin
Keyword(s):  
Philosophy Of Science ◽  
Present Article ◽  
Literature Search ◽  
A Priori ◽  
Scientific Progress ◽  
Research Report ◽  
Research Results ◽  
Different Types ◽  
Replication Crisis ◽  
Post Hoc

Hypothesizing after the results are known, or HARKing, occurs when researchers check their research results and then add or remove hypotheses on the basis of those results without acknowledging this process in their research report ( Kerr, 1998 ). In the present article, I discuss 3 forms of HARKing: (a) using current results to construct post hoc hypotheses that are then reported as if they were a priori hypotheses; (b) retrieving hypotheses from a post hoc literature search and reporting them as a priori hypotheses; and (c) failing to report a priori hypotheses that are unsupported by the current results. These 3 types of HARKing are often characterized as being bad for science and a potential cause of the current replication crisis. In the present article, I use insights from the philosophy of science to present a more nuanced view. Specifically, I identify the conditions under which each of these 3 types of HARKing is most and least likely to be bad for science. I conclude with a brief discussion about the ethics of each type of HARKing.

Combinations of Morphine with Ketamine for Patient-controlled Analgesia

2003 ◽  
Vol 98 (5) ◽  
pp. 1195-1205 ◽  
Author(s):  
Gorazd Sveticic ◽  
Andrea Gentilini ◽  
Urs Eichenberger ◽  
Martin Luginbühl ◽  
Michele Curatolo
Keyword(s):  
Lumbar Spine ◽  
Side Effects ◽  
Drug Concentration ◽  
Optimization Procedure ◽  
Hip Surgery ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Lockout Interval ◽  
Novel Method ◽  
Low Incidence

Background According to previous studies, the addition of ketamine to morphine for intravenous patient-controlled analgesia (PCA) may be beneficial. The authors developed and applied a new model to optimize the combination of morphine, ketamine, and a lockout interval for PCA after lumbar spine and hip surgery. Methods One-hundred two patients undergoing lumbar spine or hip surgery participated in the study. The analgesic effect of PCA during 48 h after surgery was optimized under restrictions dictated by side effects. Initially, eight combinations of morphine, ketamine (expressed as drug concentration in the solution administered), and a lockout interval (i.e., minimal allowed time between two consecutive PCA boluses) were empirically chosen and investigated. To determine subsequent combinations, an optimization model was applied until three consecutive steps showed no decrease in pain score. Results The authors analyzed 12 combinations with an allowed morphine and ketamine range in a PCA solution of 0-2 mg/ml and a lockout interval range of 5-12 min. During the optimization procedure, a reduction in mean pain scores with a low incidence of side effects was observed. The procedure converged to a morphine-to-ketamine ratio of 1:1 and a lockout interval of 8 min. Conclusions Using a novel method to analyze drug combinations, the study supports combinations of morphine with ketamine in a ratio of 1:1 and a lockout interval of 8 min for postoperative PCA following spine and hip surgery.

scholarly journals Patient-Controlled Epidural Analgesia in Labour — is a Continuous Infusion of Benefit?

1992 ◽  
Vol 20 (1) ◽  
pp. 15-20 ◽  
Author(s):  
M. J. Paech
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Patient Controlled Analgesia ◽  
Self Administration ◽  
High Quality ◽  
Active Labour ◽  
Background Infusion ◽  
Significant Difference ◽  
Continuous Background ◽  
Single Blind

A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia — bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. Up to three additional staff-administered supplements of 0.5% bupivacaine 4 ml (20 mg) were allowed. There was no significant difference between groups with respect to pain relief, supplementary boluses required, satisfaction, side-effects or details of patient-controlled epidural analgesia, with the exception of greater fentanyl usage in the bolus plus infusion group (P < 0.003). Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.

scholarly journals Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 211 ◽  
Author(s):  
Jihoon Hwang ◽  
Sang Kee Min ◽  
Yun Jeong Chae ◽  
Gang Mee Lim ◽  
Han Bum Joe
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Background Infusion ◽  
Randomised Controlled

Owing to a lack of studies investigating the effect of adjustments in fentanyl background infusion (BI) with patient-controlled analgesia (PCA) on postoperative analgesia, we evaluated three BI regimens with fentanyl PCA for acute postoperative pain management. This randomised controlled trial enrolled 105 patients, who were assigned to three parallel groups: constant rate BI of 2 mL/h (CRBI group); time-scheduled decremental BI of 6, 2 and 1 mL/h (TDBI group); and BI rates optimised to the demand of PCA (POBI group). The incidence of insufficient analgesia, visual analogue scale (VAS) pain score and side effects were evaluated. The incidence of insufficient analgesia in the post-anaesthesia care unit was lower in the TDBI and POBI groups than the CRBI group. Incidence of insufficient analgesia in the ward was lower in the POBI group than the CRBI group. Postoperative VAS scores were significantly lower in the TDBI and POBI groups for up to 4 h and 24 h, respectively, compared with the CRBI group. Side effects and infused fentanyl dose were highest in the CRBI group. Adjusting BI rate based on time or patient demands could improve postoperative analgesia and reduce side effects. Compared to a constant BI rate, PCA-optimised BI achieved higher patient satisfaction.

MAKNA ISLAM SEBAGAI AGAMA RAHMATAN LIL ALAMIN PERSPEKTIF PARTAI-PARTAI ISLAM PERIODE 2014-2019 (Studi terhadap Pernyataan Petinggi Partai Islam dalam Menanggapi Isu SARA)

2019 ◽  
Vol 3 (2) ◽  
pp. 129-149
Author(s):  
Robiatul Adawiyah
Keyword(s):  
Alternative Model ◽  
A Priori ◽  
Scientific Basis ◽  
Data Sources ◽  
Journal Articles ◽  
Literature Study ◽  
Related Literature ◽  
Online Newspapers ◽  
Islamic Parties ◽  
Universal Nature

The purpose of this paper is to re-understand the concept of Islam as a religion that rahmatan lil alamin in the perspective of Islamic parties in Indonesia, especially in the period 2014 - 2019. some a priori towards Islam then afraid to study Islam. In the midst of such conditions the term rahmata lil alamin can be an alternative model of Islam that is complained of by many groups. Ironically, this term is interpreted without sufficient scientific basis, it can even be said to have been a meaning bias. By using a socio-anthropolinguistic approach from online-based data, in this paper the authors use a literature study, which is looking for sources of written data that have relevance to the problem being studied. While the data sources that are used both in the form of books, journal articles, magazines and online newspapers are trusted. Based on the study of literature, the data collection techniques both primary and secondary authors use literature techniques and related literature. With this writing the authors hope the concept of Islam rahmatan lil alamin in the perspective of Islamic parties in Indonesia get clarity so that the meaning of Islam rahmatan lil alamin can truly reflect the universal nature and uphold the value of humanity that is fair and civilized and justice for all Indonesian people in particular and all humanity in general

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