PATIENTS ASSESSMENT AND ACCEPTANCE OF PAT IENT-CONTROLLED INTRANASAL ANALGESIA

Patient-controlled intravenous analgesia (i.v.-PCA) represents the gol d standard in the management of acute postoperative pain, However, in many countries i.v.-PCA is rarely used. Recent clinical studies demons trated that intranasal fentanyl titration provides a rapid and safe fo rm and pain management, In the present study we investigated patients' acceptance and assessment of patient-controlled intranasal analgesia (PCINA) and compared it to intravenous PCA and the customarily prescri bed pain therapy. Material and Methods. After approval by the local et hics committee and written informed consent, 79 ASA physical status I or II patients were investigated on the first postoperative day follow ing orthopaedic surgery. The patients were allocated either to the PCI NA group (a maximum of 0.025mg fentanyl over 6 min), to the i.v.-PCA g roup (0.025 mg fentanyl bolus, lockout interval 6 min) or to a group o f patients who received the customarily prescribed pain management. Fo llowing the 8-h Investigation period, the patients were questioned reg arding their satisfaction with the pain therapy using a 6-point rating scale (ranging from 1=very good to 6=not acceptable). The patients we re furthermore asked to name the advantages and disadvantages of their pain management. Results. Three patients in the i.v.-PC4 group had to be excluded due to pain at the injection site and one patient in the PCINA group because of a surgical complication. Seventy-five patients were finally included, 25 patients per group. No statistically signifi cant Intergroup differences regarding age, weight, height and initial pain intensity (evaluated by a 101-point numeric rating scale) were de monstrated, The patients' satisfaction with the mode of pain managemen t was significantly higher in the PCINA (median ''good'') and in the i .v.-PCA group (median ''good'') than in the group who received the cus tomarily prescribed pain management (median ''satisfactory''). This di fference was statistically significant (P=0.0001). No statistically si gnificant difference was demonstrated between the PCINA and i.v.-PCA g roups, The patients in the PCINA and in the i.v.-PCA group stated as m ain advantages the rapid onset of action and good pain relief (n=25 an d n=25, respectively), as well as their independence from the doctor o r nurse (n=12 and n=13). The main disadvantages were pain on injection in the i.v.-PCA group and too frequent fentanyl administrations in th e PCINA group (n=6). Discussion. The results demonstrate that the pati ents' satisfaction with PCINA is comparable to that with i.v.-PCA. Bot h PCINA and i.v.-PCA were assessed as superior to the customarily pres cribed pain management (P=0.0001). Patients' acceptance of a given for m of pain management is mainly related to its efficiency. However, sid e effects such as pain on injection with i.v.-PCA, or frequent opioid administration with PCINA, must be considered when assessing a method of pain control. Patients' global assessment includes both efficiency and side effects. PCINA represents an interesting alternative non-inva sive method for postoperative pain management.