Trial: Patient-Controlled Analgesia in the ED is Effective for Non-Traumatic Abdominal Pain
Currently, patients arriving in emergency departments may be administered morphine intravenously by a nurse. Whilst this is safe and works, it takes up nursing time.
Two randomised controlled trials carried out by the Plymouth Hospitals NHS Trust and Plymouth University Peninsula Schools of Medicine and Dentistry, and managed by the Peninsula Clinical Trials Unit at Plymouth University in the UK, set out to assess the effectiveness of patient-controlled analgesia (PCA) devices.
The trials assessed patient controlled analgesia in the ED following admission in two groups - patients with pain from traumatic injury and patients with non-traumatic abdominal pain. The results, published online in The BMJ, show that patient-controlled analgesia is statistically and clinically superior for patients with non-traumatic abdominal pain when compared with standard methods of pain relief delivery. In patients with pain from traumatic injury, the results were more uncertain.
Both trials had a patient sample of 200, all of whom presented with moderate to severe pain and were expected to be admitted to hospital for at least 12 hours.
In the trial relating to patients presenting with abdominal pain, PCA users reported an average total pain score of 35.3 compared with 47.3 for those receiving usual pain relief.
The other trial, which included patients with pain from traumatic injuries, showed that total pain reported by those using PCA and those treated via usual pain relief methods were similar. Those using PCA reported an average total pain score of 44, compared to 47.2 for those who did not.
Another interesting finding was that patients in the trauma PCA group were almost twice as likely to be very or perfectly satisfied with their treatment compared with patients receiving routine care.
Professor Jason Smith, Consultant in Emergency Medicine at Plymouth Hospitals NHS Trust and Professor of Emergency Medicine at Plymouth University Peninsula Schools of Medicine and Dentistry, led the studies.
He said: "We were surprised that these two studies produced quite different results, but there are several possible reasons that have subsequently been suggested. Other factors may be important in patients with traumatic injuries, such as the effect of splinting on limb injuries."
He added: "Notwithstanding, my take on this is that in emergency patients who are in pain (either abdominal pain or pain from traumatic injuries), PCA should be considered as a possible treatment option, particularly in patients whose pain is difficult to manage. We have, on the back of the results of these studies, set up a clinical protocol for the use of PCA in emergency patients at Plymouth Hospitals NHS Trust."
Smith JE, Rockett M, Creanor S et al. (2015) PAin SoluTions In the Emergency Setting (PASTIES)—patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial. BMJ, 350 doi: http://dx.doi.org/10.1136/bmj.h3147 (Published 21 June 2015)
Published on : Tue, 23 Jun 2015
Print as PDF
The HAMILTON-T1 combines for the first time the functionality of a fully featured intensive care unit ventilator with the compactness and ruggedness required for transport. This is why the HAMILTON-T1 enables you to provide optimal ventilation therapy...
17 critical parameters from a blood sample as small as 45 µL Not available in the US When the sample is small but your diagnostic needs are big, the ABL90 FLEX PLUS blood gas analyzer provides critical insights with a turnaround time of less than...
The fully featured ICU ventilator, HAMILTON-MR1, guarantees uncompromised continuous ventilation care from the ICU to the MRI scanner and back. Its reliability and high performance, with advanced lung-protective strategies and patient-adaptive modes,...
Medos hemofilters pro are used for efficient and gentle hemofiltration during extracorporal circulation.Medos hemofilters pro do not need to be pre-flushed and can be used immediately. This guarantees a safe and quick hemofiltration.