Patient-controlled versus nurse-controlled post-operative analgesia after caesarean section

Authors
Amin Ebneshahidi 1
Mojtaba Akbari 2
Bahram Heshmati 1
1 Department of Anesthesiology, Sadi Hospital; Persia Research Center, Isfahan, Iran
2 Persia Research Center; Isfahan University of Medical Sciences, School of Medicine, Isfahan, Iran
Abstract
Background:The aim of this study was to compare the differences in the quality of analgesia by patient-controlled analgesia (PCA) and nurse-controlled analgesia (NCA) for post-caesarean section analgesia.
Materials and Methods:350 women who undertake elective cesarean section were assigned to the three groups. Group I (n=200), IV-PCA morphine; group II (n=100), IV-PCA methadone; group III (n=50) NCA morphine. Data collected during the 24 h observation period included visual analog scale (VAS) pain and patient satisfaction scores, the incidence of nausea and vomiting, severe sedation and pruritis.
Results: VAS pain scores for each time at which it was evaluated were higher for NCA group than other groups. Also patient satisfaction was significantly increased in the IV-PCA Group as compared with group III. The prevalence of pruritis was higher for NCA group than other groups.
Conclusion:In post caesarean section, PCA morphine or methadone improves 24-h VAS compared with NCA.
Keywords
Caesarean section
morphine
methadone
patient-controlled analgesia
nurse-controlled analgesia
1. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural analgesia: A meta-analysis. JAMA 2003;290:2455-63.  Back to cited text no. 1
    
2. De Leon-Casasola OA, Parker BM, Lema MJ, Groth RI, Orsini-Fuentes J. Epidural analgesia versus intravenous patient-controlled analgesia. Differences in the postoperative course of cancer patients. RegAnesth 1994;19:307-15.  Back to cited text no. 2
    
3. Flisberg P, Rudin A, Linner R, Lundberg CJ. Pain relief and safety after major surgery: A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiol Scand 2003;47:457-65.  Back to cited text no. 3
    
4. Hudcova J, McNicol E, Quah C, Lau J, Carr DB. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2006;4:3348.  Back to cited text no. 4
    
5. Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth 2001;87:36-46.  Back to cited text no. 5
    
6. Viscusi ER. Patient-controlled drug delivery for acute postoperative pain management: A review of current and emerging technologies. Reg Anesth Pain Med 2008;33:146-58.  Back to cited text no. 6
    
7. Lavand'homme PM, Roelants F, Waterloos H, De Kock MF. Postoperative Analgesic Effects of Continuous Wound Infiltration with Diclofenac after Elective Cesarean Delivery. Anesthesiology 2007;106:1220-5.  Back to cited text no. 7
    
8. Ahmad-Nia S, Delavar B, Eini-Zinab H, Kazemipour S, Mehryar AH, Naghavi M. Caesarean section in the Islamic Republic of Iran: Prevalence and some sociodemographiccorrelates. East Mediterr Health J 2009;15:1389-98.  Back to cited text no. 8
    
9. Gadsden J, Hart S, Santos AC. Post-Cesarean Delivery Analgesia. Anesth Analg 2005;101:62-9.  Back to cited text no. 9
    
10. Lim Y, Jha S, Sia AT, Rawal N. Morphine for post-caesarean section analgesia: Intrathecal, epidural or intravenous? Singapore Med J 2005;46:392-6.  Back to cited text no. 10
    
11. Lavand'homme PM, Roelants F, Waterloos H, De Kock MF. Postoperative analgesic effects of continuous wound infiltration with diclofenac after elective cesarean delivery. Anesthesiology 2007;106:1220-5.  Back to cited text no. 11
    
12. Sinatra RS, Chung KS, Silverman DG, Brull SJ, Chung J, Harrison DM, et al. An evaluation of morphine and oxymorphone administered via patient-controlled analgesia (PCA) or PCA plus basal infusion in postcesarean-delivery patients. Anesthesiology 1989;71:502-7.   Back to cited text no. 12
    
13. Sinatra RS, Lodge K, Sibert K, Chung KS, Chung JH, Parker A Jr, et al. A comparison of morphine, meperidine, and oxymorphone as utilized in patient-controlled analgesia following cesarean delivery. Anesthesiology 1989;70:585-90.  Back to cited text no. 13
    
14. Warwick D, Kim S, Marlene L, Gin T. Postoperative Analgesic Requirement after Cesarean Section: A Comparison of Anesthetic Induction with Ketamine or Thiopental. Anesth Analg 1997;85:1294-8.  Back to cited text no. 14
    
15. Walder B, Schafer M, Henzi I, Tramèr MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain: A quantitative systematic review. Acta Anaesthesiol Scand 2001;45:795-804.  Back to cited text no. 15
    
16. Pettersson PH, Lindskog EA, Owall A. Patient-controlled versus nurse-controlled pain treatment after coronary artery bypass surgery. Acta Anaesthesiol Scand 2000;44:43-7.  Back to cited text no. 16
    
17. Bainbridge D, Martin JE, Cheng DC. Patient-controlled versus nurse-controlled analgesia after cardiac surgery: A meta-analysis. Can J Anaesth 2006;53:492-9.  Back to cited text no. 17
    
18. Nayar R, Sahajanand H. Does anesthetic induction for Cesarean section with a combination of ketamine and thiopentone confer any benefits over thiopentone or ketamine alone? A prospective randomized study. Minerva Anestesiol 2009;75:185-90.  Back to cited text no. 18
    
19. Munro AJ, Long GT, Sleigh JW. Nurse-administered subcutaneous morphine is a satisfactory alternative to intravenous patient-controlled analgesia morphine after cardiac surgery. Anesth Analg 1998;87:11-5.  Back to cited text no. 19
    
 
Advanced Biomedical Research
Volume 2012, March
March 2012
Pages 1-4