Abstract
A prospective randomized controlled study was performed to assess the efficacy and safety of patient-controlled analgesia (PCA) in patients undergoing thoracotomy. This method was compared with a conventional pain management technique consisting of regularly scheduled im injections of analgesics. Forty adult patients were randomly assigned to receive intravenous PCA or im meperidine treatment over a 48-hr period after surgery. Care was taken to optimize analgesia in patients of both groups. The MeGill Pain Questionnaire, visual analogue and verbal-numeric scales were administered at regular intervals to measure various components of the patients’pain experience, degree of pain relief, adverse side effects and overall treatment efficacy. Functional recovery after surgery was also examined. The results showed good and comparable analgesia with both pain-control methods. However, a greater number of patients receiving im injections required dosage adjustments than in the PCA group. Patients’ and nurses’ evaluations of overall treatment efficacy also favoured PCA treatment. There were no major group differences in the side effect profile. Recovery pattern was also comparable in the two groups except for the length of hospitalisation. There were fewer long-stay patients in the PCA than in the im group. Meperidine intake was similar in both groups but considerable interpatient variation was seen. In conclusion, PCA is a safe, effective and individualized treatment method for controlling pain after thoracotomy. There appears to be some clinical advantages of PCA over im dosing regimens for analgesia after thoracotomy.
Résumé
Une étude prospective dûment contrôlée fut effectuée afin d’évaluer l’efficacité et la sécurité de l’auto-analgésie intraveineuse (patient-controlled analgesia: PCA) chez des patients ayant subi une thoractomie. Cette méthode était comparée à un mode conventionnel d’analgésie où des injections intramusculaires (im) d’analgésiques étaient administrées de façon régulière. Quarante patients adultes furent assignés au hasard à l’un ou l’autre groupe de traitement où de la mépéridine était adminsitrée soit en mode PCA, soit en mode im. L’étude s’est échelonnée sur une période de 48 hr après la chirurgie. L’obtention d’une analgésie optimale a fait l’objet d’une attention particulière et ce, chez les patients des deux groupes. Le questionnaire MeGill sur la douleur de même que des échelles de type visuel analogique et verbal-numérique furent administrés à intervalles fréquents afin de mesurer différentes composantes de la douleur des patients, le degré de soulagement, les effets secondaires et l’efficacité globale du traitement. Certains paramètres de récupération fonctionnelle ont également été mesurés. Les résultats ont démontré une analgésie adéquate et comparable avec les deux types de traitement. Toutefois, un nombre plus élevé de patients du groupe im a nécessité des changements de dosage par rapport au groupe PCA. Les mesures d’efficacité globale obtenues en fin de traitement auprès des patients et des infirmières militaient également en faveur du mode PCA. Le profil des effets secondaires ne montrait pas de différence majeure entre les deux groupes. Les paramètres de récupération étaient également comparables sauf pour le séjour hospitalier qui était moindre chez les patients du groupe PCA. La consommation de mépéridine était similaire chez les deux groupes mais les quantités variaient considérablement d’un patient à l’autre. En conclusion, le PCA apparaît être une méthode efficace et sécuritaire pour soulager la douleur post-thoracotomie; elle foumit un traitement individualisé et avantageux par rapport au mode traditionnel d’injections im.
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Boulange, A., Choinière, M., Roy, D. et al. Comparison between patient-controlled analgesia and intramuscular meperidine after thoracotomy. Can J Anaesth 40, 409–415 (1993). https://doi.org/10.1007/BF03009508
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DOI: https://doi.org/10.1007/BF03009508