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Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain

  • Review
  • Intervention

Authors


Abstract

Background

Patients may control postoperative pain by self-administration of intravenous opioids using devices designed for this purpose (patient controlled analgesia or PCA). A 1992 meta-analysis by Ballantyne found a strong patient preference for PCA over conventional analgesia but disclosed no differences in analgesic consumption or length of postoperative hospital stay. Although Ballantyne's meta-analysis found that PCA did have a small but statistically significant benefit upon pain intensity, Walder's review in 2001 did not find a significant differences in pain intensity and pain relief between PCA and conventionally treated groups.

Objectives

To evaluate the efficacy of PCA versus conventional analgesia (such as a nurse administering an analgesic upon a patient's request) for postoperative pain control.

Search methods

Randomized controlled trials (RCTs) were identified from the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2004, Issue 3), MEDLINE (1966 to 2004), and EMBASE (1994 to 2004). Additional reports were identified from the reference lists of retrieved papers.

Selection criteria

RCTs of PCA versus conventional analgesia that employed pain intensity as a primary or secondary outcome were selected. These trials included RCTs that compared PCA without a continuous background infusion versus conventional parenteral analgesic regimens. Studies that explicitly stated they involved patients with chronic pain were excluded.

Data collection and analysis

Trials were scored using the Oxford Quality Scale. Meta-analyses were performed of outcomes that included analgesic efficacy assessed by a Visual Analog Scale (VAS), analgesic consumption, patient satisfaction, length of stay and adverse effects. A sufficient number of the retrieved trials reported these parameters to permit meta-analyses.

Main results

Fifty-five studies with 2023 patients receiving PCA and 1838 patients assigned to a control group met inclusion criteria. PCA provided better pain control and greater patient satisfaction than conventional parenteral 'as-needed' analgesia. Patients using PCA consumed higher amounts of opioids than the controls and had a higher incidence of pruritus (itching) but had a similar incidence of other adverse effects. There was no difference in the length of hospital stay.

Authors' conclusions

This review provides evidence that PCA is an efficacious alternative to conventional systemic analgesia for postoperative pain control.

摘要

背景

病患自控式鴉片類藥物止痛與傳統鴉片類藥物止痛對手術後疼痛的比較

病患也許能控制手術後疼痛藉由自我管理使用設備注射靜脈內鴉片類藥物達到這個目的(病患自控是止痛或PCA) 。Ballantyne 在1992年作一項統合分析發現跟傳統止痛方式比較是病患比較喜歡用PCA但在手術後醫院停留時間和止痛藥消耗量上是沒有什麼區別的。雖然Ballantyne 的統合分析發現PCA 對減輕疼痛程度不多但在統計上有重大意義, 2001年Walder 的回顧在使用PCA 和傳統地止痛方式之間比較在減輕疼痛強度和止痛上沒有重大差別。

目標

評估PCA與傳統止痛藥物對手術後疼痛控制效果的比較(譬如護理人員根據患者的請求給予止痛藥) 。

搜尋策略

隨機控制試驗是從Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library2004, Issue 3), MEDLINE (1966 to 2004), and EMBASE (1994 to 2004)去搜尋. 從之前的研究中發現其他報告的結果.

選擇標準

選擇隨機控制試驗包括使用PCA與傳統止痛劑以疼痛作為主要或次要的結果。這些試驗包括隨機控制試驗,比較沒有連續性注射的PCA和傳統注射的止痛方式。研究明確地敘述他們包含的患者排除了慢性疼痛的病患。

資料收集與分析

試驗的疼痛分數使用了Oxford Quality Scale。評估疼痛效果包含使用Visual Analog Scale (VAS),止痛藥物消耗量,病患的滿意度,住院天數和副作用來做整合的分析。之前回顧研究數目指出這些指標足夠來做整合分析。

主要結論

55項研究中符合納入標準的有2023 名患者接受PCA止痛和1838 名患者被分配到控制組。PCA與傳統病患需要才給止痛的方法比較提供了較好的疼痛控制並且增加了病患的滿意度。病患使用PCA的組別比起控制組使用更多的鴉片類藥物還有更高的發癢機會(癢)但有副作用發生的機會則是差不多。在住院的天數方面兩組是差不多的。

作者結論

這項回顧提供證據顯示PCA 對手術後止痛是一般常用止痛方式之外的另一種有效選擇。

翻譯人

本摘要由三軍總醫院詹舜名翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

病患自控式鴉片類藥物止痛與傳統鴉片類藥物止痛對手術後疼痛的比較。病患也許能控制手術後疼痛藉由自我管理使用設備注射靜脈內鴉片類藥物達到這個目的(病患自控是止痛或PCA) 。手術後PCA 藉由經過設計的泵浦作為管理靜脈內注射小劑量的鴉片類藥物來達到這個目的(比方說嗎啡) 。之前研究發現與傳統止痛方式作比較,譬如護理人員根據患者的請求給予止痛藥,病患是比較喜歡使用PCA 作為止痛。這項回顧顯示PCA與傳統止痛方法比較提供了較好的疼痛控制並且增加了病患的滿意度。病患在使用PCA這組使用了較大的劑量和有較高發癢的機會, 但其他副作用在兩組之間是差不多的。

Plain language summary

Patient controlled opioid analgesia versus conventional opioid analgesia for controlling postoperative pain

Patients may control postoperative pain by self-administration of intravenous opioids using devices designed for this purpose (patient controlled analgesia or PCA). Postoperative PCA involves self-administration of small doses of opioids (such as morphine) intravenously by means of a programmable pump designed for this purpose. Previous studies have shown that often patients prefer PCA to traditional methods of pain management, such as a nurse administering an analgesic upon a patient's request. This review demonstrated that PCA provided slightly better pain control and increased patient satisfaction when compared with conventional methods. Patients tended to use higher doses of medication with PCA and suffered a higher occurrence of itching, but otherwise adverse effects were similar between groups.

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