Patient-controlled versus nurse-controlled analgesia after cardiac surgery--a meta-analysis

Area of Science:

• Anesthesiology and Pain Management
• Critical Care Medicine
• Evidence-Based Medicine

Background:

• Patient-controlled analgesia (PCA) is often considered superior to nurse-controlled analgesia (NCA) for postoperative pain management.
• Concerns exist regarding the safety and resource utilization of PCA compared to NCA.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials comparing PCA and NCA.
• To evaluate the impact of PCA on clinical and resource outcomes in postcardiac surgical patients.

Main Methods:

• A comprehensive search of multiple databases (Medline, Cochrane Library, Embase) was conducted up to August 2005.
• Included randomized controlled trials comparing PCA and NCA.
• Primary outcome: Visual Analogue Scale (VAS) pain scores. Secondary outcomes: morphine consumption, length of stay, and adverse events.

Main Results:

• PCA significantly reduced VAS scores at 48 hours postoperatively (WMD -0.73, 95% CI -1.19, -0.27).
• PCA resulted in significantly increased cumulative morphine consumption at 24 hours (WMD 6.84 mg, 95% CI 0.97, 12.72 mg) and 48 hours (WMD 10.46 mg, 95% CI 2.02, 18.9 mg).
• No significant differences were found in other outcomes like ICU/hospital stay or adverse events, though these were often under-reported.

Conclusions:

• In postcardiac surgical patients, PCA improves pain control at 48 hours compared to NCA.
• PCA is associated with increased morphine consumption in the short term (24 and 48 hours).