Pain management in cardiac surgery patients: Comparison between standard therapy and patient-controlled analgesia regimen

Objective: To compare standard nurse-based pain therapy with a patient-cont rolled analgesia (PCA) regimen. Design: Prospective, randomized study. Setting: Single-institutional. clinical investigation in an urban, universi ty-affiliated hospital. Participants: Sixty patients undergoing elective first-time cardiac surgery were included. Interventions: In 30 patients, a standard analgesic regimen was used, and i n 30 patients, a PCA regimen was used. The perioperative and postoperative management was similar for all patients. Measurements and Main Results: Degree of sedation, satisfaction, and pain ( by visual analog scale [VAS]) was assessed within the first 3 postoperative days. Vital capacity (VC) and forced expiratory volume in 1 second (FEV1) were measured using a portable spirometry system. Cortisol and troponin T ( TnT) plasma levers were also measured. The expectation of pain was similar in both groups, and the postoperative pain score was significantly lower in the PCA than in the standard group throughout the study period. Significan tly more piritramid was used in the PCA (total, 75.6 +/- 33.4 mg) than in t he standard group (total, 20.1 +/- 31.9 mg). VC and FEV1 were significantly lower in the standard group compared with the PCA patients. Cortisol and T nT plasma levels were similar in both groups. Frequency of side effects wer e similar for both groups. Conclusion: Because of the beneficial effects with regard to degree of pain and satisfaction, pain management using PCA systems can be recommended for cardiac surgery patients. It appears to be superior to standard nurse-base d pain therapy. Copyright (C) 1998 by W.B. Saunders Company.