Patient controlled oral analgesia with morphine.
OBJECTIVE
When using strong oral opioids for postoperative pain management, demand titration is desirable. A device for patient controlled oral analgesia (PCORA) and first results of its use for oral titration of morphine are presented.


METHODS
The PCORA-device is a modified Baxter-PCA-on-demand system (maximum bolus volume: 0.5 ml; flow rate for filling bolus volume: 0.5 ml.hr-1). The demand PCORA-volumes were measured at specific time intervals and PCORA was compared with customarily prescribed pain therapy (CPPT) for postoperative pain management. On the first postoperative day, 20 orthopaedic ASA I or II patients received, in a randomised, cross-over trial, either PCORA (300 min) followed by CPPT (300 min) (Group I) or vice versa (Group II). The PCORA-device permitted a maximum dose of 15 mg morphine per 60 min and CPPT was performed by the ward doctor or nurse. Pain intensity (101-point numerical rating scale) and side effects were evaluated at 30 min intervals.


RESULTS
The accuracy of the bolus volume delivered by the PCORA-device was 89.2 +/- 0.85% (mean +/- SEM), of manufacturer's specifications. PCORA pain intensity decreased over time whereas CPPT pain intensity did not (P < 0.001). PCORA-morphine requirements were 61.5 +/- 5.2 mg (Group I) and 52.5 +/- 8.5 mg (Group II) (NS; mean +/- SEM). The handling of the PCORA-device presented no problem to any patient.


CONCLUSIONS
Patient controlled oral analgesia is an effective and non-invasive mode of postoperative pain management. The PCORA-device is reliable and easy to use.
Striebel
H W
HW
Department of Anaesthesiology and Intensive Care Medicine, Benjamin Franklin Medical Center, Free University of Berlin, Germany. anae@ukbf.fu-berlin.de
Römer
M
M
Kopf
A
A
Schwagmeier
R
R
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000295:instrumentation*; D018592:Cross-Over Studies; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D011446:Prospective Studies
D009020:Morphine