PATIENT-CONTROLLED ANALGESIA FOR POSTOPER ATIVE PAIN RELIEF - PROSPECTIVE-STUDY ON TECHNOLOGY FOR MEDICAL-SURGICAL INPATIENTS

Patient-controlled analgesia (PCA) is rarely used on surgical wards de spite described advantages of this method as compared to conventional techniques. Uncertainties in patient selection and insufficient evalua tion of this technique may explain these circumstances. The aim of our study was to evaluate PCA on general surgery and traumatology wards b y means of standardized criteria for technology assessment (i. e. safe ty, practicability, benefit for patients and medical staff) and the ef ficacy of pain relief. In a prospective study we investigated 120 pati ents. In phase I, we performed analgesic therapy with tramadol/metamiz ol (50 ASA status I-IV patients). In phase II, piritramid had been app lied to 70 ASA status I-II patients after an intermediate analysis of phase I. In 7 % of the patients technical problems led to an early int erruption even at the end of the study period. There were, however, no incidents which caused vital problems for the patients. A mean postop erative pain level of 55 visual analogue scale points (0-100 point sca le) was achieved with tramadol/metamizol. PCA was stopped in 16 % of t he patients due to the occurance of nausea or vomiting and in two pati ents due to insufficient pain relief. The use of piritramid in phase I I led to lower pain levels and no interruptions of PCA because of inef fectivity or nausea/vomiting. The acceptance of PCA in both phases was excellent; 83 % of the patients and 76 % of the nursing staff judged PCA as being satisfactory; 87 % of the patients would prefer PCA in fu ture and 52 % of the nursing staff felt that PCA was less time and wor k consuming in comparison to conventional pain treatment. The results of our study let us conclude that PCA is an effective method for posto perative pain relief on surgical wards. However, high costs of the PCA -pumps and a high rate of technical problems are still disadvantageous . The utilization of PCA as well as the development of PCA-concepts ha ve to be future tasks for surgeons in order to improve the patients' s atisfaction.