COMPARISON OF PATIENT-CONTROLLED ANALGESIA AND NURSE-CONTROLLED INFUSION ANALGESIA AFTER CARDIAC-SURGERY

A randomized, controlled clinical trial was conducted on 72 patients u ndergoing elective cardiac surgery to compare patient-controlled analg esia (PCA) to nurse-titrated infusion of morphine. Pain and nausea sco res were assessed at 5, 20, 32 and 44 hours after cardiopulmonary bypa ss. Serum cortisol estimations were performed at 24 and 48 hours, and morphine consumption was measured at 0-24 and 24-48 hours. There was n o difference between pain scores (P=0.72), nausea scores (P=0.52), ser um cortisol at 24 and 48 hours (P=0.32 and P=0.34) and morphine consum ption at 0-24 and 24-48 hours (P=0.16 and P=0.12). There was also no d ifference in the time to tracheal extubation (P=0.79) and discharge fr om ICU (P=0.64). There was a significant association bet ween pain and serum cortisol at 48 hours (P=0.023). This study also found a tenfold difference in the amount of morphine used (range = 11 to 108 mg), wit h no significant association with patient age or sex. We could find no significant benefit from the routine use of PCA in cardiac surgical p atients.