The usefulness of PCA includes giving a rapid and predictable results, and patients use less narcotic.
(Nendick, M. (2000). Patient satisfaction with post-operative analgesia. Nursing Standard, 14(22), 32-37.)
Post-op pain is known to have an impact on patient movement and patient recovery from surgery. Patient-controlled Analgesia (PCA), with the intravenous or epidural route, has been used widely in post-op pain management. The usefulness of PCA includes giving a rapid and predictable results, and patients use less narcotic.
Purpose:
The purpose of this study is to compare outcomes of 2 methods of PCA, epidural and IV analgesia, in term of mobility, patient satisfaction, length of stay, and side effects and to examine the relationship between patient satisfaction and analgesic side effects in adult patients undergoing total knee replacement.
Sample:
This study was conducted between 1996-1997 in an orthopedic hospital with a convenience sample of 61 (age range of 45-90 years) patients who were undergoing total knee replacement. These patients were free from drug or alcohol dependency, suspected intolerance to any narcotic, and had no history of bleeding disorder or taking anticoagulation medicine during the study time. Subjects were randomly assigned into either the IV group (31 patients) or the epidural group (30 patients) by using the hospital ID number. Same group of surgeons performed all of the operations for both groups.
Data collection tools:
1) self assessment form contained visual analogue scales (VAS) measuring three different points of time, breakfast, lunch, and bedtime. The VAS was a 10cm in length used to measure the intensity of pain or nausea. The anchor points used were "no pain" to "worst pain" and "no sickness" to "vomiting all the time." Patients completed this form three times per day, starting on their operation day, for seven days.
2) questionnaire to measure patients' perceptions of the analgesia used. This tool contained yes or no answers to questions of any problems patients experience with analgesia and whether they would use the same method again. Patients completed this form on discharge day or after seven days, whichever came first.
Procedure:
All patients received a loading dose of opiate and an anti-emetic before their operation were completed. Both epidural and IV infusion continued for an average of 48 hours post-operatively. All patients received background infusions while asleep, avoiding breakthrough pain and increases pain on walking.
Epidural placement was done before surgery. Drugs were procaine 0.5 % and diamorphine 1 mcg/ml prescribe according to age and weight.
Continuous IV infusion: patients received morphine sulphate 1 mg/ml in normal saline 0.9 % Loading doses were given before anaesthetic reversal. Dosages and lockout periods were adjusted to allow for maximum comfort at rest and for movement.
Results:
1. No significant difference in pain or nausea between the two methods of analgesic administration. Both routes appear to give satisfactory analgesic effects. Regarding background infusion: pain scores were lower in the morning than in the evening during infusion period. When the infusion had been discontinued, pain scores were slightly higher in the morning.
2. Two thirds of patients in both groups reported no side effects, the remaining reported having itching (6.6% in epidural versus 3.3% in IV) and urine retention (13.1% versus 6.6% IV). Post-operative delerium occurred in 4 patients total, but 2 were from epidural and 2 from IV suggesting the route of delivery did not impact the development of delerium. No correlation between mobility, length of stay and age.
3. 59% of patients felt they could control the PCA to get good pain control (27.8% epidural, 31.1% IV). 26.2% felt they could get fair pain control (18% epidural vs. 8.2% IV) and 6.6% felt they could obtain only poor pain control (1.6% epidural vs 4.9% IV).
4. No significant differences in patient satisfaction between epidural and IV group. Patient satisfied with PCA (82% ; 44.2% epidural versus 37.7% IV gr.). A total of 8.2% patients were not satisfied (1.6% in epidural gr. and 6.6% in IV gr.). Similar number in both group say yes to have the same type of analgesia again while 1.6 % epidural and 6.6% IV said no. No correlation between length of stay and the route of administration.
Summary:
This study provided no
evidence to support claimed association between epidural route of
administration and more onsistent pain relief and more rapid rehabilitation. No
correlation between length of stay and route of administration of
post-operative analgesia. No greater satisfaction with epidural administration
than IV administration.