Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data Export

@article{citeulike:4297198, abstract = {BackgroundApproximately 30-80\% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem. MethodsWe analysed prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system. ResultsOf 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0-100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02\%; 1:4741) or epidural abscess (0.014\%; 1:7142) after PCEA was 1:2857 (0.04\%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block. ConclusionsWe demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA. 10.1093/bja/aen300}, author = {Popping, D. M. and Zahn, P. K. and Van Aken, H. K. and Dasch, B. and Boche, R. and Pogatzki-Zahn, E. M.}, citeulike-article-id = {4297198}, citeulike-linkout-0 = {http://dx.doi.org/10.1093/bja/aen300}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/18945716}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=18945716}, day = {1}, doi = {10.1093/bja/aen300}, journal = {Br. J. Anaesth.}, keywords = {anaesthetics, analgesia, bja, pain}, month = {December}, number = {6}, pages = {832--840}, posted-at = {2009-04-10 12:04:35}, priority = {2}, title = {Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data}, url = {http://dx.doi.org/10.1093/bja/aen300}, volume = {101}, year = {2008} }

TY - JOUR ID - citeulike:4297198 L3 - citeulike-article-id:4297198 N2 - BackgroundApproximately 30-80% of postoperative patients complain about moderate to severe post-surgical pain, indicating that postoperative pain treatment is still a problem. MethodsWe analysed prospectively collected data on patients in a university hospital receiving systemic and epidural patient-controlled analgesia and continuous peripheral nerve block (CPNB) documented by the acute pain service team in a computer-based system. ResultsOf 18 925 patients visited in the postoperative period between 1998 and 2006, 14 223 patients received patient-controlled epidural analgesia (PCEA), 1591 i.v. patient-controlled analgesia (IV-PCA), 1737 continuous brachial plexus block, and 1374 continuous femoral/sciatic nerve block. Mean dynamic and resting pain scores (VAS 0-100) were significantly lower for peripheral or neuroaxial regional analgesia compared with patient-controlled systemic opioid analgesia (P<0.05). The risk of a symptomatic spinal mass lesion including epidural haematoma (0.02%; 1:4741) or epidural abscess (0.014%; 1:7142) after PCEA was 1:2857 (0.04%). Neurological complications after CPNB occurred in two patients who received interscalene brachial plexus block. ConclusionsWe demonstrated that PCEA, IV-PCA, and CPNB are safe and efficient. Although all of these treatment strategies provide effective analgesia, PCEA and CPNB provided superior pain relief compared with IV-PCA. We demonstrated that serious complications of analgesic techniques are rare but possibly disastrous necessitating a close supervision by an acute pain service. We found a low rate of adverse effects including hypotension and motor impairment and a low incidence of epidural haematoma for thoracic PCEA compared with lumbar PCEA. 10.1093/bja/aen300 IS - 6 JF - Br. J. Anaesth. EP - 840 TI - Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data VL - 101 SP - 832 KW - anaesthetics KW - analgesia KW - bja KW - pain AU - Popping, DM AU - Zahn, PK AU - Van Aken, HK AU - Dasch, B AU - Boche, R AU - Pogatzki-Zahn, EM PY - 2008/12/01/ UR - http://dx.doi.org/10.1093/bja/aen300 ER -