PATIENT-CONTROLLED INTRANASAL ANALGESIA (PCINA) FOR THE MANAGEMENT OFPOSTOPERATIVE PAIN - A PILOT-STUDY

Study Objective: To compare patient-controlled intranasal analgesia (P CINA) for post-operative pain management with ward-provided pain thera py. Design: Randomized, prospective pilot study. Setting: University m edical center. Patients: 20 ASA status I and II orthopedic patients. I nterventions: On the first postoperative day, 20 patients were randomi zed to receive either PCINA for 4 hours followed by 5 hours of ward-pr ovided pain therapy (Group 1; n = 10) or ward-provided pain therapy fo r 5 hours followed by 4 hours of PCINA (Group 2; n = 10). The PCINA de vice used permits self-administration up to a maximum 0.025 mg dose of fentanyl every 6 minutes. Pain intensity (101-point numerical rating scale) and vital signs, as well as possible side effects, were registe red at 30-minute intervals. Measurements and Main Results: Within 30 m inutes after the start of PCINA, pain Intensity had decreased signific antly in both groups. At the 60, 150, 210, 240, 270, 390, 420, and 480 minute measuring points, there was a significant intergroup differenc e in pain intensity, the level being significantly lower in the PCINA period. The handling of the PCINA device presented no problem to any p atient. The PCINA fentanyl requirement was 0.415 +/- 0.083 mg (Group 1 ) and 0.408 +/- 0.06 mg (Group 2), respectively (NS). The ward-provide d pain therapy included pethidine, tramadol, metamizole, acetaminophen , codeine, and diclofenac alone or in combination. Patient satisfactio n was greater with PCINA than with ward-provided pain therapy (p < 0.0 005). Conclusions: PCINA provides an adequate, noninvasive mode of pos toperative pain management. The PCINA device is easy to handle and off ers new perspectives in the management of postoperative pain.