Search

Study Design. A prospective, randomized, double-blind clinical trial was conducted. Objective. To compare the efficacy of patient-conitrolled analgesia (PCA) with that of patient-controlled epidural analgesia (PCEA) in terms of-overall patient satisfaction with postoperative pain -management after lumbar spine fusion. of Background -Data. in numerous surgical disciplines, PCEA and PCA have proved to be effective methods of postoperative pain control. The literature states that with PCEA, less opioid use is required during the immediate postoperative period to maintain equivalent -pain control compared to PCA. Continuous epidurat infusion has been assessed in spine fusion patients, but PCEA has not been evaluated. Furthermore, this- is the first prospective randomized clinical trial to assess overall patient-satisfaction while stratifying patients for both anx iety level and preoperative opioid use. Methods. For this study, 74 patients were assigned randomly to -one of two treatment groups, with PCA and PCEA administered in a double-blind manner for a 3-day postoperative course. All the patients. received both PCA and PCEA delivery systems. Assessment was by a blinded, independent observer. Overall patient satisfaction with pain management was assessed by a visual analog scale at the end of postoperative day 3. Secondary measures included: three scales from the Functional Independence - Measure instrument; opioid quantity; side effects; and length of hospital stay, Results. Thirty-eight patients worn randomized to PCA, and 36 were randomized. to PCEA. No baseline variable differences between the groups were observed. The results showed no difference between the groups on the following measures: overall patient satisfaction with pain management, ambulation, and length of stay. The PCA patients used significantly more opioid than the PCEA patients. Conclusions. Both postoperative analgesic regimens provided good overall patient satisfaction. The only clinical advantage of PCEA over PCA for spine fusion patients was the lower amount of opioid consumed, althouoh the PCEA group experienced significantly more side effects than the PCA group. There were no other significant differences. Therefore, patient or physician preference could select either postoperative pain management delivery system.

N-methyl-D-aspartate (NMDA) antagonists combined with opioids are thought to be effective in the control of pain states. We evaluated morphine use and analgesia in 37 patients postlaparotomy. Patients received 60 mg of oral dextromethorphan or placebo the night before and again 1 h before surgery. Morphine was titrated intraoperatively to maintain blood pressure and heart rate within 20% of baseline and postoperatively via patient-controlled analgesia (PCA). The dextromethorphan and placebo groups were compared for morphine use intraoperatively, in recovery, via PCA in the first 4 and 24 h, and total use over the study period. Pain scores at rest and on activity for the first 4 and 24 h were also compared. Intraoperatively, the dextromethorphan group required less morphine: 13.1 +/- 4.3 vs 17.6 +/- 6.0 mg (P = 0.012). Postoperatively, there was no significant difference between the dextromethorphan and placebo groups for morphine use: in the recovery room 10.9 +/- 7.7 vs 12.1 +/- 7.7 mg; the first 4 h of PCA 15.9 +/- 9.3 vs 12.7 +/- 5.1 mg; the first 24 h of PCA 76.4 +/- 44.7 vs 61.8 +/- 27.5 mg; or in total morphine use 100.4 +/- 49.5 vs 91.5 +/- 33.1 mg. Pain scores for the two groups were not statistically different throughout the study period. We conclude that 60 mg of oral dextromethorphan given the night before and repeated an hour before surgery does not provide a postoperative morphine-sparing effect or improve analgesia after laparotomy. Implications: Patients given dextromethorphan before surgery had significantly reduced intraoperative morphine requirements. However, postoperative morphine requirements were unaltered. Dextromethorphan may need to be continued postoperatively to improve postoperative analgesia. (Anesth Analg 1998;87:1135-8)