- Volume 18 Issue 4
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An Analysis on the Effect of Patient-controlled Analgesia Performed by Orthopaedic Department or Postoperative Pain Control after Shoulder and Elbow Surgery
Yum, Jae-Kwang;Kim, Jin-Hyok;Boo, Kyung-Hwan;Ahn, Soo-Hyung
- Received : 2015.09.07
- Accepted : 2015.12.04
- Published : 2015.12.31
Background: We investigated the effectiveness of pain management and the adverse events of intravenous (IV) patient-controlled analgesia (PCA) after orthopedic surgery. Methods: From September 2014 and August 2015, we performed a retrospective analysis of 77 patients who underwent orthopedic surgery of the shoulder or the elbow in our hospital. The composition of the intravenous PCA administered to the patients was as follows: 250 mg of dexketoprofen trametamol, 70 mg of oxycodone, and 0.6 mg of ramosetron, which were made up to 79 ml of normal saline. We evaluated and statistically analyzed the difference in the visual analogue scale (VAS) scores for pain at immediate postoperation, at 24 hours of PCA, at 72 hours of PCA, and after discontinuation of PCA and in the incidence of adverse events. Results: We found that VAS score decreased for 3 postoperative days and that with discontinuation of IV PCA a meaningful change in VAS score was no longer seen. Of the 77 patients, 22 presented with adverse events (28.6%). We terminated IV PCA temporarily in the 21 patients who presented with adverse events; we terminated analgesia permanently in one patient (1.2%). Consequently, 76 of 77 patients carried out IV PCA till the designated period. Conclusions: Intravenous PCA after orthopedic surgery of the shoulder or the elbow may be accompanied with adverse events. Careful assessment of the patient and treatment of the adverse outcomes are key to a successful maintenance of PCA and to a successful management of postoperative pain.
Patient-controlled analgesia;Non-steroidal anti-inflammatory agents;Oxycodone;Ramosetron;Pain measurement
- Albert TJ, Cohn JC, Rothman JS, Springstead J, Rothman RH, Booth RE Jr. Patient-controlled analgesia in a postoperative total joint arthroplasty population. J Arthroplasty. 1991;6 Suppl: S23-8. https://doi.org/10.1016/S0883-5403(08)80052-6
- White PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs. 2008;9(1):76-82.
- Vendittoli PA, Makinen P, Drolet P, et al. A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg Am. 2006;88(2):282-9. https://doi.org/10.2106/JBJS.E.00173
- Tang R, Evans H, Chaput A, Kim C. Multimodal analgesia for hip arthroplasty. Orthop Clin North Am. 2009;40(3):377-87. https://doi.org/10.1016/j.ocl.2009.04.001
- Skinner HB. Multimodal acute pain management. Am J Orthop (Belle Mead NJ). 2004;33(5 Suppl):5-9.
- Hartrick CT. Multimodal postoperative pain management. Am J Health Syst Pharm. 2004;61 Suppl 1:S4-10.
- Dorr LD, Raya J, Long WT, Boutary M, Sirianni LE. Multimodal analgesia without parenteral narcotics for total knee arthroplasty. J Arthroplasty. 2008;23(4):502-8. https://doi.org/10.1016/j.arth.2007.10.004
- Lee HJ, Shin CS, Choi BS, Yoon JY, Kwon JY, Kim HK. Effect of oral ramosetron for postoperative nausea and vomiting in surgical patients using patientcontrolled analgesia. Korean J Anesthesiol. 2008;54(1):63-8. https://doi.org/10.4097/kjae.2008.54.1.63
- Riley J, Eisenberg E, Müller-Schwefe G, Drewes AM, Arendt- Nielsen L. Oxycodone: a review of its use in the management of pain. Curr Med Res Opin. 2008;24(1):175-92. https://doi.org/10.1185/030079908X253708
- Silvasti M, Rosenberg P, Seppala T, Svartling N, Pitkanen M. Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia. Acta Anaesthesiol Scand. 1998;42(5):576-80. https://doi.org/10.1111/j.1399-6576.1998.tb05169.x
- Beltran J, Martin-Mola E, Figueroa M, et al. Comparison of dexketoprofen trometamol and ketoprofen in the treatment of osteoarthritis of the knee. J Clin Pharmacol. 1998;38(12 Suppl):74S-80S. https://doi.org/10.1002/j.1552-4604.1998.tb04380.x
- Sweetman BJ. Development and use of the quick acting chiral NSAID dexketoprofen trometamol (keral). Acute Pain. 2003;4(3-4):109-15. https://doi.org/10.1016/S1366-0071(03)00005-6
- Zippel H, Wagenitz A. Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: a multicentre, double-blind, randomised, parallel-group clinical trial. Clin Drug Investig. 2006;26(9):517-28. https://doi.org/10.2165/00044011-200626090-00005
- Koh IJ, Chang CB, Jeon YT, Ryu JH, Kim TK. Does ramosetron reduce postoperative emesis and pain after TKA? Clin Orthop Relat Res. 2012;470(6):1718-27. https://doi.org/10.1007/s11999-011-2208-0
- Choi YS, Shim JK, Yoon DH, Jeon DH, Lee JY, Kwak YL. Effect of ramosetron on patient-controlled analgesia related nausea and vomiting after spine surgery in highly susceptible patients: comparison with ondansetron. Spine (Phila Pa 1976). 2008;33(17): E602-6. https://doi.org/10.1097/BRS.0b013e31817c6bde
- Kehlet H, Dahl JB. The value of "multimodal"or "balanced analgesia"in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-56.
- Viscusi ER. Emerging techniques in the treatment of postoperative pain. Am J Health Syst Pharm. 2004;61 Suppl 1:S11-4.
- Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002;10(2):117-29. https://doi.org/10.5435/00124635-200203000-00007