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Online ISSN 1827-1596
Giannotti C., Lazzari A.
Regione Lombardia, Azienda USSL, Ambito Territoriale n. 14 di Chiari (Brescia), Servizio di Anestesia e Rianimazione
Background. The results of patient-controlled analgesia (PCA) in 300 patients undergoing major operations in general surgery, urology, ENT and obstetrics-gynaecology are presented.
Methods. An i.v. basic infusion was used on which the patient was able to insert, at minimum intervals pre-established by the physician, boluses of 1/4 of the hourly dose; the drugs used were ketorolac (K), (110 patients - 30 mg as a priming dose and 90 mg infused over the subsequent 24 hours), tramadol (90 patient - 100+300 mg), buprenorphine (55 patients - 0.3+0.9 mg) and a combination of ketorolac and buprenorphine (45 patients - 30 mg of K as priming dose and 60+0.6 mg in infusion). During the first 24 hours at pre-established intervals the following data were recorded: efficacy of analgesia (by means of verbal and visual analogues), degree of consciousness, systolic and diastolic blood pressure and heart rate, as well as any onset of adverse side effects, such as drowsiness, nausea, vomiting, itching, urine retention, respiratory depression, gastralgia, pyrosis, allergic reactions, disorientation and excitement.
Results. The analgesic efficacy was confirmed by values of the verbal analogue lying between 1.2 and 0.8 in all the therapeutic schemes.
The assessment of patients was carried out in the 24 hours following surgical operation, analysing analgesic efficacy and safety of the various treatments used. The number of self-administrations carried out by patients was superimposable among treatments and the 4 analgesic schemes determined a valid control of postoperative pain without influencing sensorial capacity. The safety of the various therapeutic schemes studied was also good, there were no variations in haemodynamic parameters and there was only a low incidence of side effects.
Conclusions. On the basis of personal experience, patient controlled analgesia has been demonstrated to be an effective, reliable and flexible procedure for the control of postoperative pain.