[Patient-controlled analgesia (PCA) in outpatients with cancer pain. Analysis of 1,692 treatment days].
BACKGROUND
In the home-care setting, cancer pain patients in need of parenteral analgesia have to be switched to patient-controlled analgesia using portable pumps. But there is a paucity on data on the logistic requirements or the success rate of such a cost-intensive therapy performed by specialized home-care services.


METHODS
In a retrospective study we analyzed data on care intensity, logistics and outcome of 46 consecutive palliative cancer patients with patient-controlled analgesia (PCA) in a home-care setting.


RESULTS
On days 1, 2, and 3 of PCA the switch to parenteral analgesia resulted in a significant increase of the median daily opioid dose in comparison to the dose just prior to PCA. Concurrently, pain scores were significantly reduced. The median duration of PCA was 25 days (range 2-189 days). On average, each patient was seen by the home-care team every 7.4 days. The median duration of the home visits was 60 min (range, 10-190 min). Of the visits 20% were unscheduled, most of these visits being due to problems regarding analgesia. Most patients died at home. Insufficient analgesia required prefinal hospitalization in only a single case.


CONCLUSIONS
If the indications are correct, intravenous PCA for palliative cancer pain patients results in higher opioid consumption and better pain control. Home-care PCA requires a lot of human and financial resources, but pain-related hospitalization can be prevented.
Schiessl
C
C
Schmerzambulanz der Anästhesiologischen Klinik, Universitätsklinikum, Erlangen. Christine.Schiessl@kfa.imed.uni-erlangen.de
Bidmon
J
J
Sittl
R
R
Griessinger
N
N
Schüttler
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000295:instrumentation / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D018575:Home Care Services, Hospital-Based; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy*; D012017:Referral and Consultation; D012189:Retrospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid