MANAGEMENT OF PATIENT-CONTROLLED ANALGESIA - A COMPARISON OF PRIMARY SURGEONS AND A DEDICATED PAIN SERVICE

Although Patient-Controlled Analgesia (PCA) is routinely available in most hospitals in the United States, there appears to be little standa rdization regarding who provides this valuable service to postoperativ e patients. This study evaluates the differences in PCA management pra ctices and patient outcomes between primary service (PS) physicians an d acute pain service (APS) physicians. Over a 3-mo period, 40 patients prescribed PCA by PS physicians were prospectively studied without th e knowledge of the physicians or nurses involved in PCA management. Af ter collecting PS data, a proportionate stratified random sampling pro cedure was used to select 40 APS patients matched for gender, age, and type of surgery. Data regarding patient demographics, PCA prescriptio n, changes in PCA orders, opioid consumption, reason for discontinuati on of PCA, verbal analog scale pain scores, side effects, and post-PCA pain management were analyzed. Although pain scores were not differen t between groups, APS patients had fewer side effects, were more likel y to receive a loading dose, had their PCA settings adjusted more ofte n (P < 0.05), and used more opioid. PS patients were more likely to re ceive intramuscular medications after PCA discontinuation (P < 0.05). This study demonstrates potentially important PCA management differenc es between APS and PS physicians.