Efficacy and costs of patient-controlled analgesia versus regularly administered intramuscular opioid therapy

Background: Many studies have shown the efficacy of patient-controlled anal gesia (PCA). However, it is not clear whether PCA has clinical or economic benefits in addition to efficient analgesia. The current study was designed to evaluate these issues by comparing PCA with regularly administered intr amuscular injections of opioids after hysterectomy. Methods: This prospective study included 126 patients who underwent abdomin al hysterectomy and were randomly assigned to receive PCA or regularly time d intramuscular injections of morphine during a period of 48 h. Doses were adjusted to provide satisfactory analgesia in both treatment groups. Pain a t rest and With movement, functional recovery, drug side effects, and patie nt satisfaction were measured using rating scales and questionnaires. The c osts of PCA and intramuscular therapy were calculated based on personnel ti me and drug and material requirements. Results: Comparable analgesia Was observed with the two treatment methods, with no significant differences in the incidence of side effects or patient satisfaction. The medication dosage had to be adjusted significantly more frequently in the intramuscular group than in the PCA patients. The PCA did not favor a faster recuperation time compared with intramuscular therapy i n terms of times to ambulation, resumption of liquid and solid diet, passag e of bowel gas, or hospital discharge. The results of the economic evaluati on, which used a cost-minimization model and sensitivity analyses, showed t hat PCA was more costly than regular intramuscular injections despite the f act that no costs for the pump were included in the analyses. Cost differen ces Ln nursing time favoring PCA were offset by drug and material costs ass ociated with this type of treatment. Conclusions: Compared with regularly scheduled intramuscular dosing, PCA is more costly and does not have clinical advantages for pain management afte r hysterectomy. Because of the comparable outcomes, the general use of PCA in similar patients should be questioned.