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 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 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.

scholarly journals The Development and Clinical Use of Patient-Controlled Analgesia

1988 ◽  
Vol 16 (4) ◽  
pp. 437-447 ◽  
Author(s):  
H. Owen ◽  
L. E. Mather ◽  
K. Rowley
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Terminal Care ◽  
Active Participation ◽  
Route Of Administration ◽  
Research Tool ◽  
Clinical Use ◽  
Patient Controlled Analgesia ◽  
Fundamental Research ◽  
Lockout Interval

Patient-controlled analgesia has successfully made the transition from research tool to clinical acceptability. Reliable and sophisticated patient-controlled analgesia systems are commercially available. The technique has been most used for control of postoperative pain but has been successfully used during labour, after burns and other trauma and in terminal care. Virtually every opioid has been administered by patient-controlled analgesia using almost every route of administration. It is more effective than the traditional techniques of pain control after surgery but is not automatically so. Choice of opioid and the settings chosen for demand dose and lockout interval greatly influence effectiveness. Patient-controlled analgesia requires active participation by the patient but the psychology of patient-controlled analgesia has generally been underestimated. Patient-controlled analgesia has developed empirically and many assumptions have been made; there is a need for fundamental research.

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.

Comparison of Analgesic Effect of Levobupivacaine with Dexmedetomidine and Levobupivacaine for Scalp Block before Supratentorial Craniotomy: A Randomized Controlled Trial

2020 ◽  
Vol 103 (10) ◽  
pp. 1028-1035
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Control Group ◽  
Study Group ◽  
Analgesic Requirement ◽  
Supratentorial Craniotomy ◽  
Numerical Rating ◽  
Fentanyl Consumption ◽  
Scalp Block

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

SIMULTANEOUS PHARMACOKINETICS OF MORPHINE AND MORPHINE-6-B-D-GLUCURONIDE DURING PATIENT-CONTROLLED ANALGESIA THERAPY FOR POSTOPERATIVE PAIN

Analgesia ◽  
1995 ◽  
Vol 1 (4) ◽  
pp. 524-527 ◽  
Author(s):  
Thomas H. Kramer ◽  
Ray H. d’Amours ◽  
Lester A. Zuckerman ◽  
Catherine Buettner
Keyword(s):  
Postoperative Pain ◽  
Patient Controlled Analgesia

scholarly journals Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luma Mahmoud Issa ◽  
Kasper Højgaard Thybo ◽  
Daniel Hägi-Pedersen ◽  
Jørn Wetterslev ◽  
Janus Christian Jakobsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Severe Pain ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Mild Pain ◽  
Total Hip ◽  
Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

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