PubMed · 8105715
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P J Youngs. 1993. A problem with a PCA pump.. https://doi.org/10.1111/j.1365-2044.1993.tb07620.x
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PURPOSE: To determine patients' knowledge and attitudes towards patient-controlled analgesia (PCA) costs through the use of our acute pain service quality assurance (QA) programme. METHODS: Quality Assurance questionnaires were distributed to all patients receiving PCA opioids for > 12 hr. Patients were asked to note the presence of side effects (nausea/vomiting, pruritus, urinary retention), to indicate their satisfaction with regard to their pain relief, follow-up assessments, treatment of side effects, and to recall the previous method of pain relief and their satisfaction with it. Patients were also asked to estimate the total cost of PCA (0-$50, $50-100, $100-200, > $200), and what amount if any they would be willing to pay (0-$50, $50-100, $100-200, > $200). Results obtained over a recent four month period were reviewed. RESULTS: One hundred and thirty-three questionnaires were distributed and 103 (77%) were returned. The percentage of patients rating their satisfaction as very good or excellent was 86% for pain relief, 96% for follow-up, 71% for side effect treatment, but only 43% for their previous surgical pain relief (P < 0.001). The distribution of cost estimates was 10% $50-100, 37% $100-200 and 53% > $200 with 60% willing to pay a portion of this cost. Those willing to pay were more likely to have had very good or excellent pain relief (94% vs 71%, P < 0.05) and treatment of side effects (71% vs 48%, P < 0.05) than those not willing to pay. CONCLUSIONS: Patients continue to be highly satisfied with PCA therapy and are aware of the costs involved. A majority of patients were willing to pay to obtain this service if necessary. Patients who had poorer pain relief and less efficacious treatment of their side effects were less willing to pay.
BACKGROUND AND STUDY AIMS: Previous studies have shown that patients inhaling-self-administered nitrous oxide/oxygen as a sedative/analgesic medication for colonoscopy were ready to leave the endoscopy unit on average sooner than those given conventional intravenous premedication. The aim of this study was to define the time course of recovery after nitrous oxide/oxygen sedation or intravenous opiate/benzodiazepine premedication for colonoscopy. PATIENTS AND METHODS: Consecutive colonoscopy patients were randomized to receive either a 50% nitrous oxide/oxygen mixture (n = 12), or pethidine 25-50 mg and midazolam 2.5 mg (n = 15), or no sedation (n = 10). Psychomotor function was assessed by multiple-choice reaction time, hand-eye co-ordination, and letter deletion tests before and at 15-minute intervals after colonoscopy, with the assessment carried out by an observer blinded to the sedation regime. RESULTS: The mean duration and tolerance of the procedure were similar in the three study groups. Patients receiving nitrous oxide/oxygen mixture were judged (by clinical observation) to recover more quickly than those given conventional sedation (median 8 min, range 3- 25 min, vs. median 16 min, range 3-50 min). Recovery, as judged by a return to baseline in psychomotor function tests, was complete within 30 minutes in all patients receiving the nitrous oxide/oxygen mixture, compared to 50 minutes in those given conventional intravenous sedation. CONCLUSIONS: The rapid recovery observed with nitrous oxide/oxygen sedation for colonoscopy suggests that it is safe for patients to travel unescorted after the procedure. Driving may also be safe soon after nitrous oxide/oxygen sedation, but this requires further clarification.
Our study describes an original technique of continuous popliteal sciatic nerve block (CPSB) (Group A, 60 patients) and compares its analgesic efficacy after foot surgery with intramuscular (IM) opioids (Group B, 15 patients) and intravenous patient-controlled analgesia (IV PCA) with morphine (Group C, 45 patients). CPSB was performed using Singelyn's landmarks. The sciatic nerve was localized with a short-beveled needle connected to a peripheral nerve stimulator. A 20-gauge catheter was placed at the same depth as the needle with a Seldinger technique. Thirty milliliters of 1% mepivacaine with epinephrine 1/200,000 was injected and followed by a continuous infusion of 0.125% bupivacaine with sufentanil 0.1 microgram/mL and clonidine 1 microgram/mL at 7 mL/h for 48 h. Postoperative analgesia (intravenous [IV] propacetamol [PRO] and/or IM piritramide [DIPI]) was standardized. Postoperative pain score (PPS), supplemental analgesia, and side effects were noted. CPSB was easy to perform in 55 patients (92%). In Group A, highest and mean PPS were significantly lower, and the mean dose of PRO was reduced by 62% and 36% when compared with Group B and C, respectively. Only 8% of patients required postoperative opioid in Group A compared with 91% and 100% in Groups B and C, respectively. No immediate or delayed complications other than postoperative technical problems (kinked or broken catheter 25%) were noted in Group A. In conclusion, CPSB is easy to perform, safe, and a more efficient technique than parenteral opioid for providing postoperative analgesia after foot surgery.