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Pain control similar, patient satisfaction slightly higher with patient-controlled analgesia in the ED
Clinical Question
Is patient-controlled analgesia more effective than opioid injection in the emergency department?
Bottom line
Adult patients in the emergency department experience similar pain relief within the first 30 minutes with either patient-controlled analgesia (PCA) or an injection of an opioid, with no significant difference noted over the next 90 minutes. However, after 120 minutes, patients were more satisfied with the PCA management. The delivery of the initial dose of PCA will take an average 15 minutes longer than an initial opioid injection, but this difference didn't seem to affect overall patient satisfaction. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Emergency department
Synopsis
These investigators enrolled a total of 636 adults from 4 emergency departments in the United States who needed intravenous opioid treatment for pain control. The patients—60% were women, 60% were Hispanic, and 75% had an abdominal pain score of at least 7 of 10—were randomly assigned, using concealed allocation, to receive either intravenous opioid, medication and dose at the discretion of the treating physician, or PCA consisting of a loading dose of morphine 0.1 mg/kg followed by additional doses of 1 mg with a 6-minute lock-out. Analysis was by intention to treat. Patients in the PCA group used an average 12.0 mg morphine as compared with 6.1 mg in the administered group, By 30 minutes after the initial dose in both groups, pain scores had decreased from an average of 9 (on a scale of 0 - 10) to an average of 5. Between 30 minutes to 120 minutes, pain scores, decreased slightly more on average with PCA (1.0), but this difference is not clinically relevant. Significantly more patients in the PCA group were satisfied with their pain relief (number needed to treat = 11; 95% CI 6.6 - 30.3). The median time to delivery of the initial dose of analgesia was 15 minutes longer with PCA.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
I have used PCA in my active practice and I agree that is superior single prn doses ,
Surely the most important finding here is that the self-administered group used double the amount of morphine. In this era of increased concern regarding opioid use I'm very surprised that your article didn't highlight this.
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After taking 15 minutes longer to get the drug, the PCA patients used twice as much and ended up feeling only 1 on a scale of 10 better than those who got half as much opioid in a single dose 15 minutes sooner. But they were more satisfied.!?
Was it worth it?
Now do a follow-up study, giving the single dose patients twice as much as the MD orders. Compare then who is more satisfied.