Ma. Smythe et al., PATIENT-CONTROLLED ANALGESIA VERSUS PATIENT-CONTROLLED ANALGESIA PLUSCONTINUOUS-INFUSION AFTER HIP-REPLACEMENT SURGERY, The Annals of pharmacotherapy, 30(3), 1996, pp. 224-227
OBJECTIVE: To compare the efficacy and adverse effect profile of patie
nt-controlled analgesia (PCA) versus PCA plus continuous infusion (PCA
CI) after hip replacement surgery. DESIGN: Prospective, randomized, op
en pilot study. SETTING: Large teaching institution. PARTICIPANTS: Thi
rty-four patients undergoing hip replacement or revision of hip replac
ement surgery. INTERVENTIONS: Patients were randomized to receive PCA
morphine: 1 mg with 6-minute lockout, or PCACI, using the same dose, w
ith a 0.5-1 mg/h continuous infusion, Pain intensity, sedation, narcot
ic use, injection/attempt ratio (I/A), and adverse effects were assess
ed. RESULTS: NO significant differences in pain intensity were identif
ied. Morphine use was not different between groups: PCA 61.8 +/- 35.0
and PCACI 74.2 +/- 54.9 mg (p = 0.394). A trend toward an increased 12
-hour I/A ratio was evident in the PCACI group: PCA 0.73 +/- 0.18 and
PCACI 0.86 +/- 0.17 (p = 0.073). Patient-reported adverse effects, sed
ation, and inability to sleep secondary to pain occurred similarly. Ei
ght of 18 PCACI patients required discontinuation of either the contin
uous infusion mode or of PCA therapy entirely secondary to adverse eff
ects. CONCLUSIONS: When compared with PCA therapy, PCACI was not assoc
iated with improved pain control and more patients receiving PCACI req
uired discontinuation of therapy secondary to adverse effects.