Step-by-step implementation of PCA therapy. Patient-controlled analgesia. (to avoid possible confusion with MeSH's PCA x-rsf.!).
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Analgesia↗
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Studies on PCA reaction with purified horse-globulin and inhibition of the PCA reaction using horse T-globulin in guinea pigs.
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Animals↗
Antiproliferative effects of PCA-4230, a new antithrombotic drug, in vascular smooth muscle cells.
1. In the present study we examined the effects of PCA-4230, a novel antithrombotic agent, on the growth of cultured A10 vascular smooth muscle cells (rat'aorta). 2. The action of PCA-4230 on cell proliferation and on serum-induced DNA synthesis was determined by measuring the cell number and the incorporation of the thymidine analogue 5-bromo-2'-deoxyuridine (BrdU), respectively. 3. PCA-4230 reversibly inhibited vascular smooth muscle cell proliferation. The increase in cell number was significantly reduced in the presence of 1 and 50 microM PCA-4230. 4. DNA synthesis was concentration-dependently inhibited by PCA-4230 (0.5 to 50 microM) in A10 cells that were synchronized by 48 h serum starvation and then re-stimulated by serum repletion, with an IC50 value of 13 microM. However, serum-induced DNA synthesis in bovine aortic endothelial cells was not significantly affected by PCA-4230. In addition, PCA-4230 (50 microM) caused a significant drop in PDGF-BB-mediated BrdU incorporation in A10 cells. 5. The effect of PCA-4230 on serum-induced DNA synthesis was compared to that elicited by nifedipine, another dihydropyridine-class inhibitor of vascular smooth muscle proliferation. PCA-4230 (10 microM) elicited a degree of inhibition similar to that of nifedipine at equimolar concentration. 6. To define the nature of the cell proliferation inhibition, an evaluation of cell cycle progression was undertaken. Flow cytometry studies of DNA content in synchronized cells revealed a block of the serum-inducible cell cycle progression. This inhibitory effect was markedly reduced when PCA-4230 was added 2 h after serum repletion. 7. Accordingly, PCA-4230 (50 microM) caused a 95 and 90% decrease in the elevation of c-fos and c-jun proto-oncogenes expression as evaluated by Northern blot analysis of mRNA induced early after serum addition. 8. The present results indicate that PCA-4230 inhibits vascular smooth muscle cell proliferation, in culture, by altering the cell cycle progression. Flow cytometric studies of DNA content and the down regulation of c-fos and c-jun proto-oncogenes, suggest that the drug is acting at the early G0/G1 transition phase. PCA-4230 may hold promising potential for the prevention of structural abnormalities of blood vessels associated with atherosclerosis and vascular diseases.
Animals↗
Subarachnoid and intravenous PCA versus bolus administration for postoperative pain relief in orthopaedic patients.
BACKGROUND: Patient-controlled analgesia (PCA) with intravenous piritramide and subarachnoid bupivacaine was studied during postoperative pain management in comparison with nurse-administered bolus injections. METHODS: Following general anaesthesia (n = 60) patients randomly received either 3.75-7.5 mg i.v. piritramide on demand (group P-Bolus) or via PCA (group P-PCA; initial bolus: 3.75 mg i.v. piritramide, baseline rate: 1 mg/h, demand-dose 1.5 mg, lockout time: 20 min). Following continuous spinal anaesthesia (n = 60; CSA; 28-G spinal catheter) patients randomly received a subarachnoid injection of 1.5 ml bupivacaine 0.25% every 2-4 h (group B-Bolus) or a baseline infusion of 0.5 ml/h bupivacaine 0.125% plus 0.5 ml bupivacaine 0.125% on demand via PCA (group B-PCA; lockout time: 30 min). Pain ratings were assessed hourly by patients using a visual analogue scale (0 = no pain, 100 mm = unbearable pain). STATISTICS: multivariate analysis of variance. RESULTS: While pain scores did not differ between group P-Bolus and P-PCA, group B-PCA showed the lowest pain ratings (18 +/- 22 mm) differing significantly from group B-Bolus (41 +/- 32 mm; P < 0.001). Group P-PCA required more piritramide than group P-Bolus (46 +/- 15 mg vs. 31 +/- 13 mg, P = 0.001). In contrast group B-PCA required less bupivacaine than group B-Bolus (18 +/- 4 vs. 23 +/- 7 mg, P = 0.002). CONCLUSION: PCA with CSA was more effective than nurse-administered bolus-administration of bupivacaine, while the present study failed to show superiority of i.v. PCA over i.v. bolus-administration of piritramide. PCA using the subarachnoid route is a promising concept for treatment of postoperative pain in orthopaedic patients, while the PCA piritramide regime of this study warrants improvement.
Aged↗
Enhanced androgen receptor signaling correlates with the androgen-refractory growth in a newly established MDA PCa 2b-hr human prostate cancer cell subline.
Bone metastasis is commonly found in prostate cancer (PC) patients. Although the mechanisms for the recurrence of bone metastasis-derived PC during medical or surgical castration therapy are still unclear because of the lack of suitable experimental models, one hypothesis is that enhanced androgen receptor (AR) signaling causes androgen-refractory PC growth. To test this hypothesis, we first established a novel androgen-refractory MDA PCa 2b cell subline, MDA PCa 2b-hr, which was generated in vitro from bone metastasis-derived, androgen-dependent MDA PCa 2b human PC cells after approximately 35 weeks of growth suppression by androgen-depletion treatment to mimic the clinical PC recurrence during androgen-ablation therapy. The changes of the androgen responsiveness of growth and the AR expression levels during the transition from an androgen-dependent to androgen-refractory proliferative phase through a temporal growth-suppressed phase precisely paralleled that of the basal growth rate. Furthermore, the androgen-refractory growth of MDA PCa 2b-hr cells in androgen-depleted medium was suppressed by an antiandrogen, bicalutamide. Next, we established nude mouse xenograft models to clarify whether AR signaling in MDA PCa 2b-hr cells is also enhanced in vivo. Both the MDA PCa 2b and MDA PCa 2b-hr tumors grew in gonadally intact mice, but only the MDA PCa 2b-hr tumors grew in castrated mice. The growth rate of MDA PCa 2b-hr tumors was significantly higher in gonadally intact mice than in castrated mice. Treatment with dehydroepiandrosterone pellets, which produced clinical castration levels of serum testosterone, accelerated the MDA PCa 2b-hr but not MDA PCa 2b tumor growth in castrated mice and increased blood prostate-specific antigen levels in castrated mice bearing MDA PCa 2b-hr tumors but not in mice bearing MDA PCa 2b tumors. Our data suggest that the enhanced AR signaling should be closely correlated with the androgen-refractory growth of human bone metastasis-derived PC, which might come to use adrenal androgens remaining in the blood even after castration therapy and warrant the continuation of hormone therapy for the recurrent PC.
Androgen Antagonists↗
Pediatric PCA: the role of concurrent opioid infusions and nurse-controlled analgesia.
OBJECTIVES: We designed a clinical study to determine: a) the safety and efficacy of patient-controlled analgesia (PCA) therapy in children and adolescents undergoing major operations, b) if the use of a concurrent opioid infusion improved the efficacy of conventional PCA therapy, and c) if nurse control of the PCA device was a useful alternative in the intensive care unit (ICU) setting. DESIGN: Subjects were randomly assigned to receive morphine sulfate for postoperative pain relief via intermittent PCA boluses on demand or PCA plus a continuous infusion (PCA + CI). Children (n = 12) who were unable to use the PCA device because of inadequate development level or upper extremity weakness were assigned to a nurse-controlled analgesia (NCA) group. SETTING: In the ICU of a university-based pediatric teaching hospital. PATIENTS: Fifty-four children and adolescents underwent elective scoliosis surgery. INTERVENTIONS: The PCA devices were connected to the patient's i.v. catheter immediately after surgery. Morphine sulfate was administered on demand by either the patient or an ICU nurse for pain relief during the first 72 h after the operation. MAIN OUTCOME MEASURES: Pain scores were recorded simultaneously by both the nurse and the patient using standardized visual analog scales. Opioid analgesic usage, side effects, and therapeutic interventions were recorded by the ICU nurse. RESULTS: There were no differences between the PCA and PCA + CI groups with regard to morphine use, pain relief, side effects, or patient satisfaction. Nurses consistently underestimated their patient's level of pain, and children in the NCA groups received less morphine per kilogram than those who self-administered their own analgesic medication. CONCLUSIONS: Both PCA and NCA were safe and efficient methods of analgesic administration in the pediatric ICU setting. However, use of a concurrent opioid infusion with PCA therapy did not provide any clinically significant advantages over intermittent bolus doses of the analgesic medication after scoliosis surgery. For patients unable to use a conventional PCA device, NCA is an acceptable alternative for the management of acute pain in the ICU setting.
Adolescent↗
Gabor-based kernel PCA with fractional power polynomial models for face recognition.
This paper presents a novel Gabor-based kernel Principal Component Analysis (PCA) method by integrating the Gabor wavelet representation of face images and the kernel PCA method for face recognition. Gabor wavelets first derive desirable facial features characterized by spatial frequency, spatial locality, and orientation selectivity to cope with the variations due to illumination and facial expression changes. The kernel PCA method is then extended to include fractional power polynomial models for enhanced face recognition performance. A fractional power polynomial, however, does not necessarily define a kernel function, as it might not define a positive semidefinite Gram matrix. Note that the sigmoid kernels, one of the three classes of widely used kernel functions (polynomial kernels, Gaussian kernels, and sigmoid kernels), do not actually define a positive semidefinite Gram matrix either. Nevertheless, the sigmoid kernels have been successfully used in practice, such as in building support vector machines. In order to derive real kernel PCA features, we apply only those kernel PCA eigenvectors that are associated with positive eigenvalues. The feasibility of the Gabor-based kernel PCA method with fractional power polynomial models has been successfully tested on both frontal and pose-angled face recognition, using two data sets from the FERET database and the CMU PIE database, respectively. The FERET data set contains 600 frontal face images of 200 subjects, while the PIE data set consists of 680 images across five poses (left and right profiles, left and right half profiles, and frontal view) with two different facial expressions (neutral and smiling) of 68 subjects. The effectiveness of the Gabor-based kernel PCA method with fractional power polynomial models is shown in terms of both absolute performance indices and comparative performance against the PCA method, the kernel PCA method with polynomial kernels, the kernel PCA method with fractional power polynomial models, the Gabor wavelet-based PCA method, and the Gabor wavelet-based kernel PCA method with polynomial kernels.
Algorithms↗
D-PCa-2: a novel transcript highly overexpressed in human prostate and prostate cancer.
Identification of genes selectively expressed in tumors or individual tissues is a crucial prerequisite for molecular diagnosis and treatment of cancer by addressing molecular targets. By screening an expression database, we identified the novel gene D-PCa-2 (Dresden prostate carcinoma 2), which is highly overexpressed in normal prostate tissue and prostate carcinoma (PCa). The corresponding transcript contained an open reading frame of 453 nucleotides encoding a putative protein of 150 amino acids. A large part of exon 8 of the D-PCa-2 gene shows strong similarity to the high-mobility-group nucleosomal binding protein 2 (HMGN2) cDNA. The highly specific transcription of the D-PCa-2 gene in normal and malignant prostate tissues and in a few additional tumors was demonstrated by using multiple tissue dot blot, cancer profiling dot blot and real-time PCR analyses. Examination of 18 pairs of tumorous and nontumorous prostate tissues from PCa patients by quantitative RT-PCR revealed D-PCa-2 transcripts in all specimens. The potential usefulness of D-PCa-2 as a sensitive marker for metastatic prostate carcinoma cells in lymph nodes was demonstrated by the detection of one LNCaP cell in 1 x 10(5) normal lymph node cells using real-time RT-PCR. Examination of 22 lymph nodes from PCa patients either containing metastatic prostate cancer cells or diagnosed as cancer-free was in full concordance with histopathologic diagnoses. These results validate D-PCa-2 as a transcript with high tissue specificity and with a potential application in the diagnosis of PCa.
Aged↗
Comparison between a disposable and an electronic PCA device for labor epidural analgesia.
PURPOSE: The aims of the present study were (1) to investigate if a disposable patient-controlled analgesia (PCA) device can be used for labor analgesia and (2) to evaluate the device by midwives and parturients. METHODS: Forty healthy parturients were divided into two groups and received combined spinal epidural analgesia for labor pain relief. Following intrathecal administration of 3 mg ropivacaine and 1.5 microg sufentanil, either a disposable PCA device (Coopdech Syrinjector; Daiken Medical, Osaka, Japan) or an electronic PCA device (IVAC PCAM PCA Syringe Pump; Alaris, Basingstoke, UK) was connected to the epidural catheter, and 0.15% ropivacaine with sufentanil 0.75 microg/ml was used for continuous infusion and PCA. For an electronic PCA device, continuous infusion rate, bolus dose, lockout time, and hourly limit were set at 4 ml/h, 3 ml, 15 min, and 16 ml, respectively. For a disposable PCA device, continuous infusion rate, bolus dose, and an hourly limit were set at 4 ml/h, 3 ml, and 16 ml, respectively, but lockout function was not available. RESULTS: No differences were observed between the groups concerning demographic data, obstetric data, and outcome of labor. Anesthetic requirements (disposable, 9.7 +/- 4.7 ml/h; electronic, 8.2 +/- 4.0 ml/h) and VAS score during the delivery (disposable, 26 +/- 25; electronic, 21 +/- 22) were similar between the groups. Midwives praised the disposable PCA device as well as the electronic one. CONCLUSION: The present results imply that the disposable PCA device can be an alternative to the electronic PCA device for labor analgesia.
Adult↗
Development of a physical characteristics assessment (PCA): a checklist for determining appropriate computer access for individuals with cerebral palsy.
The physical characteristics assessment (PCA), a newly developed illustrated checklist, is designed for use by allied health and education professionals to identify a viable method for an individual with cerebral palsy to access a computer. The PCA was developed in response to a documented void of such assessments in the literature. The value of PCA was assessed with respect to content validity, clinical utility, reliability (inter-rater), and opinion of persons with cerebral palsy and health and education professionals. Professionals (n = 72) and persons with cerebral palsy (n = 78) from 20 sites in Canada, Chile, England, Israel, Spain, and the United States participated in the study. Statistically, the PCA produced a highly significant (p < 0.001) assessment time savings compared with non-PCA methods. A statistically significant difference in the number of user/computer interface changes during five post-assessment computer training sessions was not shown between the PCA and non-PCA methods. Inter-rater reliability ranged between 90% and 100% (n = 33 pairs). Both persons with cerebral palsy assessed via the PCA and professionals using the PCA gave positive opinions. Overall results support the value of the PCA.
Cerebral Palsy↗
Continuous epidural infusion of ropivacaine for postoperative analgesia after major abdominal surgery: comparative study with i.v. PCA morphine.
We have compared the quality of three regimens of postoperative analgesia (continuous epidural administration of ropivacaine (Ropi. group), epidural ropivacaine and patient-controlled analgesia (PCA) with i.v. morphine (Ropi. + PCA group) and PCA morphine alone (PCA group)) during the first postoperative 24 h in a multicentre, randomized, prospective study. Postoperative analgesia was studied in 130 patients after major abdominal surgery performed under general anaesthesia. The ropivacaine groups received 20 ml of epidural bolus ropivacaine 2 mg ml-1 via the epidural route at the end of surgery, followed by continuous infusion of 10 ml h-1 for 24 h. The Ropi. + PCA group also had access to i.v. PCA morphine 1 mg, with a 5-min lockout. The PCA group received morphine as the sole postoperative pain treatment. The two ropivacaine groups had lower pain scores (P < 0.01) than the PCA group. Morphine consumption was higher in the PCA group (P < 0.05) than in the two ropivacaine groups. The quality of pain relief was rated as good or excellent in 79-85% of patients in the three groups. The percentage of patients without motor block increased between 4 and 24 h from 61% to 89% in the Ropi. group, and from 51% to 71% in the Ropi. + PCA group.
Abdomen↗
The efficacy of adding a continuous intravenous morphine infusion to patient-controlled analgesia (PCA) in abdominal surgery.
The effect of adding a continuous infusion of morphine 1 mg/hr to patient-controlled intravenous analgesia was studied in a randomized double-blind trial. Ninety-six patients scheduled for abdominal surgery were enrolled; 38 received PCA and continuous infusion (PCA + C), 45 received PCA alone and 13 were excluded because of protocol violations. PCA was delivered via an ABBOTT 4200 pump with settings of morphine 1 mg bolus and five-minute lockout in both groups. A separate pump delivered a continuous infusion of morphine 1 mg/ml (PCA + C) or 9% normal saline (PCA) at 1 ml/hr for three postoperative days. Pain was assessed by hourly verbal pain scores (VPS) and daily visual analog pain scores at rest and on movement (VAS(rest), VAS(move)). PCA delivered morphine and the demand to delivery ratio (D/D ratio) were used as indirect indicators of pain. These were assessed during daytime (0800-2200 hours), sleep (2200-0500 hours) and on first waking (0500-0800 hours). Patient demographics were similar. Patients receiving a continuous infusion had lower pain scores during the first 24 hours but not thereafter (VPS P = 0.04, VAS(move) P = 0.02). The PCA group delivered more PCA morphine during 0500-0800 hours and 0800-2200 hours on the first day only. There was no significant difference in the D/D ratio for any time period during the three days. Total morphine delivery was greater in the PCA + C group on the second and third postoperative days (P = 0.009 and P = 0.0001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Abdomen↗
Drug susceptibility of PCA in WBB6F1-W/Wv mice.
Our previous study revealed that passive cutaneous anaphylaxis (PCA) can be produced in congenitally mast cell-deficient WBB6F1-W/Wv (abbreviated as W/Wv) mice on sensitization with undiluted or slightly diluted allogeneic and xenogeneic antisera but not on sensitization with allogeneic monoclonal immunoglobulin (Ig)E and IgG1 antibodies regardless of the antibody concentration [1]. In view of these findings, the present study was conducted to characterize PCA in this strain from its drug susceptibilities using mast cell-bearing WBB6F1-(+)/+ (abbreviated as +/+) and B6D2F1 mice as references. PCA in W/Wv mice mediated by a low dilution (1:4) of hyperimmune serum to bovine serum albumin of the B6D2F1 mouse origin was markedly suppressed by CV-6209, an antagonist of platelet-activating factor (PAF), but not by antihistamines such as cyproheptadine and oxatomide. In contrast, PCA in +/+ and B6D2F1 mice mediated by a high dilution (1:128) of the anti-serum (virtually by IgG1 antibody) was nearly completely suppressed by antihistamines but not by CV-6209. A remarkable difference between PCA in W/Wv and reference mice was also observed in the susceptibility to monoclonal anti-mouse granulocyte (Gr-1) antibody: PCA in W/Wv mice was potently suppressed by the 1- to 3-day pretreatment with this antibody but that in references was not at all. Putting these present results together with the previous finding that anti-granulocyte antibody greatly reduces circulatory Gr-1+ leukocytes, 1 to 3 days after the treatment [2], it is highly probable that PCA in W/Wv mice mediated by some antibody isotypes other than IgE and IgG1 is produced by PAF mainly released from Gr-1+ cells, while IgG1 antibody-mediated PCA in mast cell-bearing reference mice is evoked by histamine derived from mast cells. PCA homologous to that in W/Wv mice could also be produced in the reference mice on sensitization with undiluted or slightly diluted antiserum, when generalized blueing due to excess IgG1 antibody was removed by the oxatomide treatment before the antigen challenge.
Animals↗
Evidence for dual serotonergic projections to neocortex: axons from the dorsal and median raphe nuclei are differentially vulnerable to the neurotoxin p-chloroamphetamine (PCA).
Previous studies have shown that there are morphologically dissimilar serotonergic (5-HT) axon types in rat cerebral cortex which are differentially sensitive to the neurotoxic effects of certain psychotropic drugs: methylenedioxyamphetamines (MDA and MDMA) and p-chloroamphetamine (PCA) cause degeneration of fine 5-HT axon terminals in cortex, while sparing beaded axons. Moreover, a recent anterograde transport study suggests that fine and beaded 5-HT axons arise from the dorsal raphe (DR) and median raphe (MR) nuclei, respectively. These data led us to propose that the DR projection to neocortex is selectively vulnerable to the neurotoxic effects of PCA, while the MR projection is resistant; this hypothesis was tested in the present study by comparing retrograde axonal transport of the fluorescent tracer Fluoro-Gold in PCA-treated and control rats. Using this method, only axons that survive PCA treatment can take up and transport the injected label back to the cell bodies of origin, thus allowing us to determine which raphe-cortical projections remain intact after PCA. The results show that PCA administration produces a loss of fine 5-HT axon terminals in neocortex and a concomitant reduction in the number of retrogradely labeled neurons in the DR (77% decrease), when compared to controls. In contrast, beaded 5-HT axon terminals are spared and the number of labeled neurons in the MR remains unchanged after PCA. These results demonstrate that DR and MR projections to cortex are differentially vulnerable to PCA: fine axon terminals arise from neurons in the DR and are highly sensitive to the neurotoxic effects, whereas beaded axons from the MR are resistant. We therefore propose that there are two anatomically and functionally separate 5-HT projections to cortex having different (1) nuclei of origin, (2) axon morphology, (3) regional distributions, and (4) pharmacological properties. Since the mood-altering substances MDA, MDMA, and PCA act specifically upon 5-HT axon terminals from the dorsal raphe nucleus, DR neurons may be preferentially involved in the control of affective state.
Amphetamines↗
Decomposing ERP time-frequency energy using PCA.
OBJECTIVE: Time-frequency transforms (TFTs) offer rich representations of event-related potential (ERP) activity, and thus add complexity. Data reduction techniques for TFTs have been slow to develop beyond time analysis of detail functions from wavelet transforms. Cohen's class of TFTs based on the reduced interference distribution (RID) offer some benefits over wavelet TFTs, but do not offer the simplicity of detail functions from wavelet decomposition. The objective of the current approach is a data reduction method to extract succinct and meaningful events from both RID and wavelet TFTs. METHODS: A general energy-based principal components analysis (PCA) approach to reducing TFTs is detailed. TFT surfaces are first restructured into vectors, recasting the data as a two-dimensional matrix amenable to PCA. PCA decomposition is performed on the two-dimensional matrix, and surfaces are then reconstructed. The PCA decomposition method is conducted with RID and Morlet wavelet TFTs, as well as with PCA for time and frequency domains separately. RESULTS: Three simulated datasets were decomposed. These included Gabor logons and chirped signals. All simulated events were appropriately extracted from the TFTs using both wavelet and RID TFTs. Varying levels of noise were then added to the simulated data, as well as a simulated condition difference. The PCA-TFT method, particularly when used with RID TFTs, appropriately extracted the components and detected condition differences for signals where time or frequency domain analysis alone failed. Response-locked ERP data from a reaction time experiment was also decomposed. Meaningful components representing distinct neurophysiological activity were extracted from the ERP TFT data, including the error-related negativity (ERN). CONCLUSIONS: Effective TFT data reduction was achieved. Activity that overlapped in time, frequency, and topography were effectively separated and extracted. Methodological issues involved in the application of PCA to TFTs are detailed, and directions for further development are discussed. SIGNIFICANCE: The reported decomposition method represents a natural but significant extension of PCA into the TFT domain from the time and frequency domains alone. Evaluation of many aspects of this extension could now be conducted, using the PCA-TFT decomposition as a basis.
Analog-Digital Conversion↗
The excretion mechanism of the spin label proxyl carboxylic acid (PCA) from the rat monitored by X-band ESR and PEDRI.
Proton electron double resonance imaging (PEDRI) was used for monitoring in vivo the distribution, metabolism and, in particular, the excretion mechanism of the exogenous nitroxide free radical proxyl carboxylic acid (PCA) in the rat. PCA clearance half-lives through liver, abdominal vessels, and renal tissues were determined from a series of PEDRI images for normal rats (n = 5) and rats treated with probenecid (n = 5), a competitive inhibitor of the tubular secretion process. The approximately doubled renal half-lives of the treated animals suggest that tubular secretion accounts for about 50% of PCA renal loss in the normal rat and reabsorption is insignificant. PCA binding to bovine serum albumin was investigated by X-band ESR and the bound fraction was found to be less than 10% of the total PCA. Most probably, PCA binds to hydrophilic sites. Blood PCA concentration investigated by X-band ESR exhibited biphasic behavior and PEDRI results confirmed the in vivo metabolic reduction of PCA by rat liver cells.
Animals↗
Patient satisfaction with intravenous PCA or epidural morphine.
In many institutions postoperative patients may receive morphine for analgesia administered into the epidural space, epidural opioid analgesia (EOA), or through intravenous self-administered patient-controlled analgesia pumps (PCA). Although a number of studies have compared the two approaches with regard to efficacy and side effects, there is less known with regard to patient satisfaction and its sources. In this study, 711 patients using PCA morphine and 205 patients receiving epidural morphine following a variety of gynaecological, urological, orthopaedic, and general surgical procedures rated their satisfaction with the method they used on a 0-10 verbal analogue satisfaction scale (0 = very dissatisfied; 10 = very satisfied). A consecutive subset of 100 patients (50 from EOA group and 50 from the PCA group) underwent further evaluation to identify advantages and disadvantages of the technique used which contributed to their satisfaction and/or dissatisfaction. Overall satisfaction (mean +/- SD) in the two large groups was 8.6 +/- 1.8 for PCA and 9.0 +/- 1.5 for EOA (P < 0.01). In the subset of 100 patients, there were differences between the EOA and PCA groups with regard to the advantages and disadvantages selected. Patients in the PCA group identified "personal control" and "method worked quickly" as advantages whereas patients receiving EOA selected "clear mind," "effective relief resting," and "effective relief while moving or coughing." The single disadvantage identified more frequently by PCA patients was "pain immediately after surgery before method became effective." Disadvantages identified more frequently by EOA patients were "side effects" and "poor pain relief." We conclude that overall patient satisfaction was high whether patients received PCA or EOA.(ABSTRACT TRUNCATED AT 250 WORDS)
Activities of Daily Living↗
Morphine/ondansetron PCA for postoperative pain, nausea, and vomiting after skull base surgery.
OBJECTIVE: Patients who underwent skull base procedures have been noted to experience appreciable pain. This study examines pain after surgery and the effectiveness of patient controlled analgesia (PCA) with combination morphine ondansetron for analgesia and control of emesis. STUDY DESIGN AND SETTING: A total of 120 skull base surgery patients were randomized to receive placebo, morphine, or morphine ondansetron. Demographic and intraoperative variables were recorded along with pain, nausea, vomiting, and rescue analgesics. Total PCA use, hospital stay, satisfaction, and cost were also compared. RESULTS: Demographically the groups were similar. Pain was elevated with placebo PCA, and this group averaged twice as many analgesic rescues. Total usage time was lower with placebo PCA. Morphine ondansetron PCA had the lowest pain score with highest satisfaction. Nausea and vomiting was similar but female patients had more vomiting regardless of PCA group. CONCLUSIONS AND SIGNIFICANCE: The use of morphine PCA reduced pain and did not appreciably increase nausea or vomiting. The addition of ondansetron produced no real benefit and its PCA use cannot be justified. EBM RATING: A-1b.
Adolescent↗