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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1998 March;64(3):89-97

language: Italian

Post­op­er­a­tive anal­gesia ­with PCA in 300 ­patients. Com­par­ison of ­four ther­a­peutic ­schemes

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.

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