[Patient-controlled analgesia with piritramide for postoperative pain relief in general surgery: a prospective...

Many studies investigated patient-controlled analgesia (PCA) in the postoperative period in recovery rooms under anaesthesiologic monitoring but reports on the advantages and indications of PCA in surgical wards are scarce. The aim of this prospective study therefore was to investigate PCA as a routine technique in surgical wards. In particular we were interested in safety and in the efficacy of analgesia.

Subjects were 50 patients (ASA status I-II) recovering from surgery (thyroidectomy, herniotomy, anorectal surgery). All patients gave their informed consent. The pump used was the Injektomat CP PACOMR (Fresenius, Bad Homburg), and PCA was performed with piritramide. The demand dose was set at 2 mg, with a pump refractory time of 5 min between valid demands and a 24-h maximum of 60 mg. There was no continuous analgesic infusion. Standardized monitoring was carried out with measurement of blood pressure, pulse and respiratory rate. The intensity of pain was measured with a 100-point visual analogue scale at rest and during movement on the day before the operation and twice daily after the operation up to the day of discharge. Complications, side-effects and the degree of satisfaction experienced by the patients and the nurses were recorded with the aid of standardized questionnaires.

The mean duration of the PCA period was 18.00+/-6.2 h (mean+/-standard deviation), and 8.5+/-7.9 demands per patient were recorded. The mean individual consumption of piritramide was 14.2+/-11.2 mg, i.e. 12mug.kg(-1).h(-1). The mean retrospective pain score was 2.4+/-1.3 on a 6-point verbal scale. The highest mean intensity of pain measured during movement was 37 points on the 100-point scale on the evening of the day of operation. The most frequent complaint during the PCA period was sedation, which occurred in 20 patients (40%). PCA was judged superior by 82% of patients when compared with previously experienced postoperative analgesia; 41 patients (82%) and 40 nurses (80%) judged PCA as good or excellent; 46 patients (92%) would prefer to receive PCA in the future. No incident led to a vital problem for the patients. PCA was stopped because of a respiratory rate of 9/min in one patient and because of systolic blood pressure <90 mmHg in another patient. Both patients were free of symptoms and subsequently made uneventful progress.

We conclude that PCA with piritramide is a safe technique when performed under routine conditions on surgical wards. However, standardized monitoring is mandatory. PCA leads to effective analgesia and consequently to greater comfort of surgical patients in the postoperative period. These conclusions hold only for patients with ASA status I-II who have undergone operations of the types listed above.