Abstract
Background
Patient-controlled analgesia (PCA) has been advocated as superior to conventional nurse-controlled analgesia (NCA) with less risk to patients. This systematic review and meta-analysis sought to determine whether PCA improves clinical and resource outcomes when compared with NCA.
Methods
A comprehensive search was undertaken to identify all randomized controlled trials of PCAvs NCA. Medline, Cochrane Library, Embase, and conference abstract databases were searched from the date of their inception to August 2005. The primary postoperative outcome was defined as mean visual analogue scale (VAS) scores. Secondary postoperative outcomes included cumulative morphine equivalents, intensive care unit (ICU) and hospital length of stay, postoperative nausea and vomiting, sedation, respiratory depression, and all-cause mortality. Odds ratios or weighted mean differences (WMD) and their 95% confidence intervals (CI) were calculated for discrete and continuous outcomes, respectively.
Results
Ten randomized trials involving 666 patients were included. Compared to NCA, PCA significantly reduced VAS at 48 hr (WMD -0.73, 95% CI -1.19, -0.27), but not at 24 hr (WMD -0.19, 95% CI -0.61, 0.24). Cumulative morphine equivalents consumed were significantly increased at 24 hr (WMD 6.84 mg, 95% CI 0.97, 12.72 mg), and at 48 hr (WMD 10.46 mg 95% CI 2.02, 18.9 mg) for PCA compared with NCA. Ventilation times, length of ICU stay, length of hospital stay, patient satisfaction scores, sedation scores, and incidence of postoperative nausea and vomiting, respiratory depression, severe pain, discontinuations, and death were not significantly different between groups, but these outcomes were generally under-reported.
Conclusions
In postcardiac surgical patients, PCA increases cumulative 24 and 48 hr morphine consumption, and improves 48-hr VAS compared with NCA.
Résumé
Objectif
Ľanalgésie auto-contrôlée (AAC) est préconisée comme supérieure à ľanalgésie traditionnelle contrôlée par ľinfirmière (ACI), avec moins de risque pour le patient. La présente revue systématique et méta-analyse a cherché à déterminer si ľAAC améliore les résultats et exige moins de ressources cliniques que ľACI.
Méthode
Une vaste recherche a été entreprise pour découvrir toutes les études randomisées et contrôlées sur ľAAC vs ľACI. Les bases de données de Medline, Cochrane Library, Embase et des comptes rendus de conférences ont été fouillées de la date de leur création à août 2005. Le principal paramètre postopératoire était les scores à ľéchelle visuelle analogique (EVA). Les paramètres postopératoires secondaires étaient les équivalents-morphine cumulatifs, la longueur du séjour à ľunité des soins intensifs (USI) et à ľhôpital, les nausées et vomissements postopératoires, la sédation, la dépression respiratoire et toute cause de mortalité. Les risques relatifs ou les différences moyennes pondérées (DMP) et leurs intervalles de confiance (IC) de 95 % ont été respectivement calculés pour des résultats discrets et continus.
Résultats
Dix études randomisées comprenant 666 patients ont été retenues. Comparée à ľACI, ľAAC a significativement réduit les scores à ľEVA à 48 h (DMP -0,73, IC de 95 % -1,19, -0,27), mais non à 24 h (DMP -0,19, IC de 95 % -0,61, 0,24). La consommation ďéquivalents-morphine cumulatifs a été significativement plus élevée à 24 h (DMP 6,84 mg, IC de 95 % 0,97, 12,72 mg) et à 48 h (DMP 10,46 mg IC de 95 % 2,02, 18,9 mg) pour ľAAC comparée à ľACI. Les temps de ventilation, la longueur du séjour à ľUSI et à ľhôpital, les scores de satisfaction du patient, les scores de sédation et ľincidence de nausées et de vomissements postopératoires, la dépression respiratoire, la douleur sévère, les interruptions et la mort ne présentaient pas de différence intergroupe significative, mais ces paramètres étaient généralement sous-déclarés.
Conclusion
Après une opération cardiaque, ľAAC augmente la consommation cumulative de morphine à 24 et 48 h et améliore les scores EVA à 48 h comparée à ľACI.
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Bainbridge, D., Martin, J.E. & Cheng, D.C. Patient-controlledversus nurse-controlled analgesia after cardiac surgery — a meta-analysis. Can J Anesth 53, 492–499 (2006). https://doi.org/10.1007/BF03022623
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DOI: https://doi.org/10.1007/BF03022623