Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain
Abstract
:1. Introduction
2. Methods
3. Results/Discussion
3.1. Predictors of Postoperative Pain
3.2. Indications and Benefits of PCA
PCA IV and/or Other Systemic Therapies * | Side Specific Infiltration or Block with or without Regional Catheters ** | Neuraxial Anesthetic Techniques *** | |
---|---|---|---|
Thoracotomy/thoracoscopy | ++ | Paravertebral block ++ | +++ |
Laparotomy | ++ | Infiltration catheters TAP block + | +++ |
Laparoscopy | +++ | Infiltration ++ | + |
Hip | +++ | ++ | ++ |
Knee | ++ | +++ | ++ |
Shoulder/upper arm | ++ | +++ | |
Spinal fusion | +++ | ++ | |
Cesarean section | ++ | TAP block ++ | +++ |
Breast surgery | ++ | Paravertebral block +++ | |
CABG | +++ | ||
Cervicofacial surgery | +++ | +++ When indicated |
3.3. Interindividual Variability
3.4. PCA Concept
3.5. Side Effects of IV-PCA
3.6. Comparison of Different PCA Medications
3.7. Adding Ketamine to PCA Morphine
3.8. Human-Related Issues and Side Effects
3.9. PCA in Children
3.10. PCA for Elderly and Frail Patients
3.11. PCA in Obese Patients
3.12. PCA in Chronic Pain Patients
3.13. Recent Modalities of PCA Administration
3.14. Other Factors Influencing Quality of Pain Management
3.15. Limitation of This Study
4. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Analgesic | Bolus Dose | Lockout Period (Minutes) |
---|---|---|
Morphine | 1 mg | 5–10 |
Fentanyl | 10 µg | 5–10 |
Hydromorphone | 0.25 mg | 5–10 |
Remifentanil | 0.5 µg/kg | 2 |
Sufentanil | 5 µg | 5–10 |
Efficiency | Side Effects | |
---|---|---|
Oxycodone | As potent as morphine | May have fewer severe side effects |
Hydromorphone | Higher incidence of CNS side effects, excitation at higher dose | |
Fentanyl | High potency +, may require more need for basal infusion rate | Lesser incidence of respiratory depression in comparison to morphine, but more programming errors |
Sufentanil | High potency ++, high therapeutic index, more predictable profile, more need for basal infusion | Lower incidence of PONV in comparison to fentanyl |
Tramadol | Ten times less potent than morphine | More PONV in some type of surgeries (e.g., spinal fusion) |
Remifentanil | Very short duration, studies mainly in labor | Higher respiratory depression, less satisfaction in comparison to epidural analgesia |
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Motamed, C. Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain. Pharmacy 2022, 10, 22. https://doi.org/10.3390/pharmacy10010022
Motamed C. Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain. Pharmacy. 2022; 10(1):22. https://doi.org/10.3390/pharmacy10010022
Chicago/Turabian StyleMotamed, Cyrus. 2022. "Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain" Pharmacy 10, no. 1: 22. https://doi.org/10.3390/pharmacy10010022
APA StyleMotamed, C. (2022). Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain. Pharmacy, 10(1), 22. https://doi.org/10.3390/pharmacy10010022