Patient-controlled analgesia versus intramuscular analgesic therapy

Area of Science:

• Anesthesiology
• Pharmacology
• Health Services Research

Background:

• Postoperative pain management is crucial for patient recovery.
• Patient-controlled analgesia (PCA) and intramuscular (i.m.) analgesic therapy are common methods for pain control.
• Evaluating the efficiency and effectiveness of different pain management strategies is essential.

Purpose of the Study:

• To compare the pharmacy and nursing time requirements for PCA and i.m. analgesic therapy.
• To assess the quality of postoperative pain control between PCA and i.m. therapy.
• To evaluate the direct costs associated with PCA versus i.m. analgesic administration.

Main Methods:

• A prospective, randomized study involving hysterectomy patients.
• Timed nursing and pharmacy activities for both PCA and i.m. therapies.
• Pain scores were collected every four hours, with patients self-administering medication via PCA or receiving i.m. injections.
• Direct costs were calculated based on drug, supplies, and maintenance for PCA, and drug costs for i.m. therapy.

Main Results:

• PCA required more nursing time (16.9 min/patient) and pharmacy time (5.1 min longer) than i.m. therapy (10.7 min/patient).
• PCA patients reported better pain control, with 40% experiencing mild or worse pain compared to 64% of i.m. patients.
• Median pain scores were mild for PCA and moderate for i.m. patients, with PCA showing lower scores at 16 and 20 hours.
• Nausea incidence was similar, but i.m. patients required more antiemetic doses.

Conclusions:

• PCA provides superior postoperative pain relief and potentially reduces the need for antiemetics compared to i.m. injections.
• While PCA demands more staff time and has higher direct costs, its benefits in pain management and patient comfort are significant.
• The findings support the use of PCA for improved outcomes in postoperative pain management, particularly for gynecologic surgery patients.