Patient-controlled Analgesia in Acute Postoperative Care Management

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23/09/19 Medical Reference this

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Patient-controlled Analgesia in Acute Postoperative Care Management 

The use of patient-controlled analgesia in acute postoperative care management

Introduction

Acute postoperative pain increases mortality and morbidity rate and delays the recovery of the patients (Chen, Yeh, & Yang, 2005). The management of acute pain in healthcare settings is challenging for healthcare professionals (Wirz et al. 2017, Collins, et.al. 2015). With most patients experiencing acute postoperative pain after undergoing surgical procedures, effective relief and prevention of acute pain can help in avoiding clinical complications and improving clinical outcomes (Grissinger, 2008). Studies have shown that the introduction of acute pain services and/or acute pain management programs can be associated with improved acute postoperative pain management, and good pain control has become an indicator of the quality of care and good clinical practice. Nevertheless, although adequate treatment of acute postoperative pain can improve patient quality of life and satisfaction with care, as well as enhance clinical resource management and reduce long-term costs of care, acute pain remains undertreated and its management is suboptimal. Based on this, it is essential to research how patient-controlled analgesia can be used in acute postoperative care management. Analysing the literature in the field will help shape the scope of my research and ultimately, my theory.

Tool: PubMed

Search terms: patient-controlled analgesia, acute postoperative care and pain management

 

 

Patient Considerations in the use of transdermal iontophoretic fentanyl

Hartrick, C., Pestano, C., Ding, L., Danesi, H., & Jones, J. (2016). Patient considerations in the use of transdermal iontophoretic fentanyl for acute postoperative pain. Journal of Pain Research, 215. doi:10.2147/jpr.s89278

           Opioids are frequently utilized in the management of acute moderate-to-severe postoperative pain immediately after surgery as part of an analgesic multimodal therapy regimen. In this article, the authors examined the iontophoretic transdermal system (ITS), which is patient controlled. Hartrick et al. noted that Fentanyl ITS offers a needle-free alternative to traditional intravenous (IV) patient-controlled analgesia (PCA) system that is as effective and safe as IV PCA. The authors noted that with fentanyl ITS, fentanyl is delivered into the systemic circulation of patients using iontophoresis. The system has been designed to be easily utilized by patients and is easy to apply by nurses. Fentanyl has been found to be as effective as morphine IV PCA in patients with moderate-to-severe postoperative pain. Overall, the use of fentanyl ITS is generally associated with a greater ease of mobility, from a patients’ perspective when compared with morphine IV PCA. In my personal opinion, Fentanyl ITS is as effective and safe as traditional IV PCA and can offered as a non-invasive alternative.

Non-invasive patient-controlled analgesia

Morlion, B., Schäfer, M., Betteridge, N., & Kalso, E. (2018). Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting. Current Medical Research and Opinion, 34(7), 1179-1186. doi:10.1080/03007995.2018.1462785

         Valid, reliable and active assessment of pain in the postoperative phase is an important factor in achieving improved postoperative pain organization and management in hospitals (Breivik et al, 2008). Acute postoperative pain is experienced by the majority of hospitalized patients undergoing surgical procedures, with many reporting inadequate pain relief and/or high levels of dissatisfaction with their pain management. Patient-controlled analgesia (PCA) ensures patient involvement in acute pain control, a key component for implementing a quality management system. In this narrative, the authors overview the clinical evidence for conventional PCA and briefly discusses new, non-invasive PCA systems, namely the sufentanil sublingual tablet system (SSTS) and the fentanyl iontophoretic transdermal system (FITS).  The authors concluded that evidence-based guidelines for acute postoperative pain management support the use of multimodal regimens in many situations. As effective and safe alternatives to conventional PCA, and with the added benefits of being non-invasive, easy to use and allowing early patient mobilization, the newer PCA systems may complement multimodal approaches, or potentially replace certain regimens, in hospitalized patients with acute postoperative pain.

 

Systematic Review of Intravenous Oxycodone in Pain Management

Tan, H. P., & Conroy, T. (2018). The Effectiveness of Intravenous Oxycodone in the Treatment of Acute Postoperative Pain: A Systematic Review. Journal of PeriAnesthesia Nursing, 33(6), 865-879. doi:10.1016/j.jopan.2017.05.010

             The inadequacies of postoperative pain control can lead to physiological and physical complications after surgery and also delay in the resumption of normal daily activities, thus decreasing the patient’s degree of satisfaction. One of the most extensively used methods of controlling postoperative pain is intravenous patient-controlled analgesia (IV-PCA). The method has been noted to improve pain control and has minimal side effects. In the implementation of IV-PCA, the choice of an appropriate analgesic and control of the appropriate dose and lockout interval are critical to the reduction of side effects and the achievement of effective analgesia. The administration of oxycodone at too high a dose to patients sensitive to opioids may not only cause minor side effects such as respiratory depression, bradycardia, apnea, hypotension, circulatory collapse, respiratory arrest, and death. Tan and Conroy (2018) noted that Intravenous (IV) opioids are administered for management of acute postoperative pain in the postanaesthetic care unit. The authors also noted that the benefits of parenteral oxycodone for acute pain management are understudied. Tan and Conroy concluded that IV oxycodone can be considered as effective analgesia for acute postoperative pain with careful regards to its adverse effects. 

References

  • Breivik, H., Borchgrevink, P. C., Allen, S. M., Rosseland, L. A., Romundstad, L., Breivik Hals, E. K., … & Stubhaug, A. (2008). Assessment of pain. BJA: British Journal of Anaesthesia, 101(1), 17-24.
  • Chen, H.H., Yeh, M.L., & Yang, H.J. (2005). Testing the impact of a multimedia video CD of patient-controlled analgesia on pain knowledge and pain relief in patients receiving surgery. International Journal of Medicine Information, 2005 Jul;74(6):437-45.
  • Collins, T.H., Crosson, J., Peikes, D., McNellis, R., Genevro, J., & Meyers, D.  (2015). Using Health Information Technology to Support Quality Improvement in Primary Care. AHRQ Publication No. 15-0031-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2015.
  • Grissinger, M. (2008). Safety and Patient-Controlled Analgesia. Part 2: How to Prevent Errors. Pharmacy and Therapeutics, vol.33(1); 2008 Jan
  • Hartrick, C., Pestano, C., Ding, L., Danesi, H., & Jones, J. (2016). Patient considerations in the use of transdermal iontophoretic fentanyl for acute postoperative pain. Journal of Pain Research, 215. doi:10.2147/jpr.s89278
  • Morlion, B., Schäfer, M., Betteridge, N., & Kalso, E. (2018). Non-invasive patient-controlled analgesia in the management of acute postoperative pain in the hospital setting. Current Medical Research and Opinion, 34(7), 1179-1186. doi:10.1080/03007995.2018.1462785
  • Tan, H. P., & Conroy, T. (2018). The Effectiveness of Intravenous Oxycodone in the Treatment of Acute Postoperative Pain: A Systematic Review. Journal of PeriAnesthesia Nursing, 33(6), 865-879. doi:10.1016/j.jopan.2017.05.010
  • Wirz, S., Conrad, S., Shtrichman, R., Schimo, K., & Hoffman, E. (2017). Clinical Evaluation of a Novel Technology for Oral Patient-Controlled Analgesia, the PCoA® Acute Device, for Hospitalized Patients with Postoperative Pain, in Pilot Feasibility Study. Pain Research Management, 2017; 2017: 7962135.

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