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Article: An audit of postoperative intravenous patient-controlled analgesia with morphine: Evolution over the last decade

TitleAn audit of postoperative intravenous patient-controlled analgesia with morphine: Evolution over the last decade
Authors
Issue Date2009
PublisherWB Saunders Co Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ejpain
Citation
European Journal Of Pain, 2009, v. 13 n. 5, p. 464-471 How to Cite?
AbstractThe development and refinement of an acute pain service based on the increased availability of clinical evidence would be expected to improve the quality of postoperative pain control. This report reviews the application of postoperative patient-controlled analgesia (PCA) using intravenous morphine in a single institution between 2002 and 2005. More than 5000 patients were evaluated and the results were compared with a similar study performed 10 years ago. Prescription of PCA had increased by more than threefold. Morphine consumption from post-operative day 1 to day 3 (19.1 vs. 26.1, 8.6 vs. 18.1 and 4.5 vs. 19.0 μg/kg/h, respectively), demand-to-delivery ratio (1.35-1.76 vs. 2.4-2.8) and the incidence of respiratory depression (0.06% vs. 2%) were significantly reduced (p < 0.001), but there was no improvement in pain relief. A substantial proportion of patients still experienced postoperative nausea (47%) and vomiting (18.5%) despite a reduction in morphine consumption. Most patients ranked PCA as good and only 0.3% were dissatisfied. We conclude that, in our institution over the last decade, PCA has become more popular for postoperative pain management but with no attendant improvement in pain relief or reduction in side effects. Using PCA alone may result in poorer quality postoperative analgesia. Our findings add to the growing body of evidence that postoperative pain management has not substantially improved despite increased adoption of acute pain services. © 2008 European Federation of Chapters of the International Association for the Study of Pain.
Persistent Identifierhttp://hdl.handle.net/10722/147264
ISSN
2015 Impact Factor: 2.9
2015 SCImago Journal Rankings: 1.189
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, CWen_US
dc.contributor.authorYing, CLAen_US
dc.contributor.authorLee, LHYen_US
dc.contributor.authorTsang, SFen_US
dc.contributor.authorTsui, SLen_US
dc.contributor.authorIrwin, MGen_US
dc.date.accessioned2012-05-29T06:01:06Z-
dc.date.available2012-05-29T06:01:06Z-
dc.date.issued2009en_US
dc.identifier.citationEuropean Journal Of Pain, 2009, v. 13 n. 5, p. 464-471en_US
dc.identifier.issn1090-3801en_US
dc.identifier.urihttp://hdl.handle.net/10722/147264-
dc.description.abstractThe development and refinement of an acute pain service based on the increased availability of clinical evidence would be expected to improve the quality of postoperative pain control. This report reviews the application of postoperative patient-controlled analgesia (PCA) using intravenous morphine in a single institution between 2002 and 2005. More than 5000 patients were evaluated and the results were compared with a similar study performed 10 years ago. Prescription of PCA had increased by more than threefold. Morphine consumption from post-operative day 1 to day 3 (19.1 vs. 26.1, 8.6 vs. 18.1 and 4.5 vs. 19.0 μg/kg/h, respectively), demand-to-delivery ratio (1.35-1.76 vs. 2.4-2.8) and the incidence of respiratory depression (0.06% vs. 2%) were significantly reduced (p < 0.001), but there was no improvement in pain relief. A substantial proportion of patients still experienced postoperative nausea (47%) and vomiting (18.5%) despite a reduction in morphine consumption. Most patients ranked PCA as good and only 0.3% were dissatisfied. We conclude that, in our institution over the last decade, PCA has become more popular for postoperative pain management but with no attendant improvement in pain relief or reduction in side effects. Using PCA alone may result in poorer quality postoperative analgesia. Our findings add to the growing body of evidence that postoperative pain management has not substantially improved despite increased adoption of acute pain services. © 2008 European Federation of Chapters of the International Association for the Study of Pain.en_US
dc.languageengen_US
dc.publisherWB Saunders Co Ltd. The Journal's web site is located at http://www.elsevier.com/locate/ejpainen_US
dc.relation.ispartofEuropean Journal of Painen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAnalgesics, Opioid - Administration & Dosage - Adverse Effectsen_US
dc.subject.meshDose-Response Relationship, Drugen_US
dc.subject.meshDrug Resistance - Physiologyen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshInfusions, Intravenous - Adverse Effects - Statistics & Numerical Dataen_US
dc.subject.meshMaleen_US
dc.subject.meshMedical Auditen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshMorphine - Administration & Dosage - Adverse Effectsen_US
dc.subject.meshOutcome Assessment (Health Care) - Methodsen_US
dc.subject.meshPain Measurement - Methodsen_US
dc.subject.meshPain, Postoperative - Drug Therapy - Physiopathology - Prevention & Controlen_US
dc.subject.meshPatient Care Teamen_US
dc.subject.meshPatient Satisfactionen_US
dc.subject.meshPostoperative Nausea And Vomiting - Chemically Induced - Epidemiology - Prevention & Controlen_US
dc.subject.meshRespiratory Insufficiency - Chemically Induced - Epidemiology - Prevention & Controlen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSelf Administration - Adverse Effects - Statistics & Numerical Dataen_US
dc.subject.meshTime Factorsen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleAn audit of postoperative intravenous patient-controlled analgesia with morphine: Evolution over the last decadeen_US
dc.typeArticleen_US
dc.identifier.emailCheung, CW:cheucw@hku.hken_US
dc.identifier.emailIrwin, MG:mgirwin@hku.hken_US
dc.identifier.authorityCheung, CW=rp00244en_US
dc.identifier.authorityIrwin, MG=rp00390en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1016/j.ejpain.2008.05.013en_US
dc.identifier.pmid18602851-
dc.identifier.scopuseid_2-s2.0-63649101673en_US
dc.identifier.hkuros160843-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-63649101673&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume13en_US
dc.identifier.issue5en_US
dc.identifier.spage464en_US
dc.identifier.epage471en_US
dc.identifier.eissn1532-2149-
dc.identifier.isiWOS:000265803400005-
dc.publisher.placeUnited Kingdomen_US

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