Patient-controlled analgesia: a comparison of dosing regimens for acute postsurgical pain.
This study compares several dosing regimens for patient-controlled analgesia (PCA) in the management of acute maxillofacial surgical pain. The dosing methods differed by presence or absence of an active drug (morphine [MS] vs saline), presence of a baseline infusion, and dose of drug delivered. Sixty-eight patients were enrolled in this prospective, randomized, double-blind, placebo-controlled trial that lasted 24 hours. The study was completed in two separate parts, each of which involved randomization of patients into four groups (part I) or three groups (part II). No significant differences were noted in pain scores in the preoperative, immediate postoperative, or 4-, 8-, 12-, or 24-hour periods among any of the groups, including the saline-only control groups; in either part I or part II of the study. Significant differences (P < .01), however, were noted in nausea and vomiting scores. Fifty percent (50%) of patients receiving MS vomited, while no patients in the saline groups vomited. This study calls into question the usefulness of PCA with MS in maxillofacial surgery patients. Pain control was questionable at best, and the rate of emesis was unacceptably high in patients with potentially compromised airways. Further research is required to determine if other analgesics provide better pain control with less nausea in the PCA system or if antiemetics can effectively be used to lower the incidence of nausea and vomiting.