title: Pain evaluation in patients receiving intravenous patient-controlled analgesia after surgery.
abstract: OBJECTIVE
  To evaluate the effectiveness of intravenous patient-controlled analgesia (PCA) in patients after surgery.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Sixty patients with American Society of Anesthesiologists physical status I-III receiving intravenous PCA for postoperative pain. The PCA was programmed to deliver morphine 1 mg or hydromorphone 0.1-0.2 mg, with a lockout interval of 10 and 6 minutes for 80% and 20% of the patients, respectively.
  
  
  RESULTS
  Patients were asked, up to 4 times during PCA use and once within 4 hours after PCA use, to describe and rate their intensity of pain at rest and after activity. During the first 12 hours of intravenous PCA use, 75% of the patients reported moderate-to-severe pain > or = 5 on a verbal numeric rating scale) at rest, 80% after activity. Corresponding values, respectively, were 33% and 72% for the 12-24-hour period, 43% and 76% for the 24-36-hour period, and 36% and 64% for the 36-48-hour period of intravenous PCA use. Within 4 hours of stopping PCA, 30% and 58% of the patients had moderate-to-severe pain at rest and after activity, respectively. In approximately 50% of patients, presence of pain was described with words signifying sensory and affective dimensions of pain. Pain control was rated as good or very good by 54% of patients during the first 12 hours of intravenous PCA. Ratings of pain control tended to improve with time.
  
  
  CONCLUSIONS
  Successful postoperative pain management using PCA is difficult to achieve on a consistent basis unless treatment is individualized. Our data support the hypothesis that small fixed doses fail to achieve adequate relief in many patients.
authors.affiliation: Department of Anesthesiology, Cooper University Hospital, Camden, New Jersey, USA. larijanig@aol.com
authors.forename: Ghassem E
authors.initials: GE
authors.lastname: Larijani
authors.forename: Imran
authors.initials: I
authors.lastname: Sharaf
authors.forename: David P
authors.initials: DP
authors.lastname: Warshal
authors.forename: Alex
authors.initials: A
authors.lastname: Marr
authors.forename: Irwin
authors.initials: I
authors.lastname: Gratz
authors.forename: Michael E
authors.initials: ME
authors.lastname: Goldberg
mesh_terms: D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D004091:Hydromorphone