Patient-controlled analgesia: does a concurrent opioid infusion improve pain management after surgery?

Article Abstract:

A minimum effective dosage of an opioid analgesic (narcotic pain reliever) to prevent pain after surgery should be definable, permitting a constant intravenous (IV) infusion and decreasing the need for injections. However, study results have not always found this method of pain therapy to be effective, and in some cases, continuous infusions may increase the need for pain medication. Because such therapy also carries risk, such as depression of breathing, the benefits must outweigh the risks to justify its use. Patient-controlled analgesia (PCA) allows patients to self-administer up to a pre-defined maximum amount of pain medication, thus accommodating individual requirements. However, the use of a continuous infusion may help these patients after surgery when they are still too sedated to dose themselves, when they need more relief with increasing physical activity, or at night so that sleep is not interrupted. Two hundred thirty women scheduled for a hysterectomy were assigned to receive one of three levels of continuous IV analgesia (0.5, 1.0, or 2.0 mg/hour of morphine) or else no analgesia (placebo). The results indicate that there is no advantage to the routine use of a continuous IV analgesia to supplement PCA. The number of supplemental doses of morphine was the same when opioids were infused. Confirming earlier findings, PCA therapy alone actually decreased the morphine requirement. The study supports the use of a conventional intermittent dosing schedule to supplement PCA therapy. It remains to be seen whether this finding also applies to men and to other types of surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Usage, Opioids, Dosage and administration, Analgesia

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Preemptive epidural analgesia and recovery from radical prostatectomy: a randomized controlled trial

Article Abstract:

Analgesic medication injected around the spinal cord at the start of surgery may substantially reduce early postoperative pain and pain many weeks after surgery. Researchers assigned 100 men undergoing surgical removal of the prostate to receive anesthetic medication or placebo by epidural catheter prior to surgery. All patients received epidural pain medication after surgery. Men who received epidural medication during surgery experienced 33% less pain while in the hospital, and significantly less pain 9.5 weeks after surgery. Early analgesia may desensitize the central nervous system to pain.

Research, Prevention, Prostatectomy

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Efficacy of postoperative epidural analgesia: a meta-analysis

Article Abstract:

Spinal anesthesia may be more effective in treating postoperative pain than opioid infusions, according to researchers who analyzed 100 studies that compared the two treatments. This was true for almost all kinds of surgery, with the possible exception of chest surgery. It was also true regardless of which anesthetic was used.

Drug therapy

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