PATIENT-CONTROLLED ANALGESIA VERSUS PATIENT-CONTROLLED ANALGESIA PLUSCONTINUOUS-INFUSION AFTER HIP-REPLACEMENT SURGERY

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.