scholarly journals Patient-Controlled Analgesia (PCA) in Acute Pain: Pharmacological and Clinical Aspects

10.5772/67299 ◽  
2017 ◽  
Author(s):  
Marcos Tadeu Parron Fernandes ◽  
Fernanda Bortolanza Hernandes ◽  
Thaís Natália de Almeida ◽  
Vitor Pinheiro Sobottka ◽  
Regina Célia Poli-Frederico ◽  
...  
Keyword(s):  
Acute Pain ◽  
Clinical Aspects ◽  
Patient Controlled Analgesia

Opioids for Anesthesia and Postoperative Pain Control

2019 ◽  
Author(s):  
Bryan Cook ◽  
Krystina Geiger ◽  
Megan Barra
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pain Management ◽  
Respiratory Depression ◽  
Acute Pain ◽  
Patient Controlled Analgesia ◽  
Opioid Agonist ◽  
Duration Of Action ◽  
Central Nervous System Depression ◽  
Organ Systems

Opioid agonists are frequently used to provide anesthesia in combination with sedatives and hypnotic agents and manage postoperative acute pain. There are many different opioid agents available that differ in their potency, onset and duration of action, metabolism, drug interactions, and side-effect profile. All opioids have distinct effects upon various organ systems, including central nervous system depression, respiratory depression, and decreased gastrointestinal motility. Fentanyl and fentanyl-derived agents (alfentanil, sufentanil, remifentanil) are most frequently used in the intraoperative period due to their quick onset and duration of action, allowing them to be easily titrated and discontinued at the completion of a procedure. Oral opioids with moderate durations of action, such as oxycodone, hydrocodone, and morphine, are commonly used for acute pain management in the postoperative setting. When oral analgesics cannot be used, intravenous patient-controlled analgesia is another option for pain management. This review contains 5 figures, 11 tables, and 59 references. Key Words: analgesia, anesthesia, central nervous system depression, fentanyl, morphine, opioid agonist, pain management, patient-controlled analgesia, perioperative, respiratory depression

Acute pain

2016 ◽  
Author(s):  
Adrian Dashfield
Keyword(s):  
Acute Pain ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Substance Misuse ◽  
Patient Controlled Analgesia ◽  
Comparative Efficacy ◽  
Acute Pain Management ◽  
Electrical Nerve Stimulation ◽  
Analgesic Drugs ◽  
Peripheral Nerve Blockade ◽  
Inflammatory Drugs

This chapter discusses the management of acute pain. It begins with an introduction which describes the benefits of acute pain management and the measurement of pain. Analgesic drugs are then described, including paracetamol, non-steroidal anti-inflammatory drugs, and opioids (including their comparative efficacy). Patient-controlled analgesia, epidural analgesia, and continuous peripheral nerve blockade are described. Transcutaneous electrical nerve stimulation and acupuncture are discussed. The management of the patient with a substance misuse disorder is discussed. The chapter concludes with a discussion of non-opioid adjuvant analgesics.

scholarly journals Ketamine versus hydromorphone patient-controlled analgesia for acute pain in trauma patients

2018 ◽  
Vol 225 ◽  
pp. 6-14 ◽  
Author(s):  
Sheila C. Takieddine ◽  
Christopher A. Droege ◽  
Neil Ernst ◽  
Molly E. Droege ◽  
Megan Webb ◽  
...  
Keyword(s):  
Acute Pain ◽  
Trauma Patients ◽  
Patient Controlled Analgesia

A patient-activated iontophoretic transdermal system for acute pain management with fentanyl hydrochloride: Overview and applications

2006 ◽  
Vol 2 (6) ◽  
pp. 314 ◽  
Author(s):  
Kevin T. Bain, PharmD, BCPS, CGP, FASCP
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Medication Administration ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Acute Pain Management ◽  
Free System ◽  
Opioid Administration ◽  
Iontophoretic Transdermal System

Opioid administration by patient-controlled analgesia (PCA) is the standard therapy for acute postoperative pain. Despite its utility in this setting, limitations of this modality do exist. Consequently, noninvasive PCA systems, including an iontophoretic transdermal system (ITS) with fentanyl hydrochloride, are under development to circumvent many of these limitations. This preprogram med, self-contained, compact, needle-free system provides pain con trol superior to that of placebo and comparable to morphine PCA in the first 24 hours after major surgical procedures. The objectives of this article are to describe the method of transdermal iontophoretic medication administration and to review the literature pertaining to the fentanyl ITS.

Hamilton Acute Pain Service Safety Study

2014 ◽  
Vol 120 (1) ◽  
pp. 97-109 ◽  
Author(s):  
James E. Paul ◽  
Norman Buckley ◽  
Richard F. McLean ◽  
Karen Antoni ◽  
David Musson ◽  
...  
Keyword(s):  
Acute Pain ◽  
Root Cause Analysis ◽  
Acute Pain Service ◽  
Patient Controlled Analgesia ◽  
Cause Analysis ◽  
Root Cause ◽  
Analysis Process ◽  
Severe Hypotension ◽  
Before And After ◽  
Address System

Abstract Background: Although intravenous patient-controlled analgesia opioids and epidural analgesia offer improved analgesia for postoperative patients treated on an acute pain service, these modalities also expose patients to some risk of serious morbidity and even mortality. Root cause analysis, a process for identifying the causal factor(s) that underlie an adverse event, has the potential to identify and address system issues and thereby decrease the chance of recurrence of these complications. Methods: This study was designed to compare the incidence of adverse events on an acute pain service in three hospitals, before and after the introduction of a formal root cause analysis process. The “before” cohort included all patients with pain from February 2002 to July 2007. The “after” cohort included all patients with pain from January 2009 to December 2009. Results: A total of 35,384 patients were tracked over the 7 yr of this study. The after cohort showed significant reductions in the overall event rate (1.47 vs. 2.35% or 1 in 68 vs. 1 in 42, the rate of respiratory depression (0.41 vs. 0.71%), the rate of severe hypotension (0.78 vs. 1.34%), and the rate of patient-controlled analgesia pump programming errors (0.0 vs. 0.08%). Associated with these results, the incidence of severe pain increased from 6.5 to 10.5%. To achieve these results, 26 unique recommendations were made of which 23 being completed, 1 in progress, and 2 not completed. Conclusions: Formal root cause analysis was associated with an improvement in the safety of patients on a pain service. The process was effective in giving credibility to recommendations, but addressing all the action plans proved difficult with available resources.

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