Comparative Effectiveness of Patient-Controlled Analgesia for Treating Acute Pain in the Emergency Department

Study objective We assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesi...

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Bibliographic Details
Published in:Annals of emergency medicine 2017-12, Vol.70 (6), p.809-818.e2
Main Authors: Bijur, Polly E., PhD, Mills, Angela M., MD, Chang, Andrew K., MD, MS, White, Deborah, MD, Restivo, Andrew, MD, Persaud, Shaun, MS, Schechter, Clyde B., MD, MA, Gallagher, E. John, MD, Birnbaum, Adrienne J., MD, MS
Format: Article
Language:English
Subjects:
Acute Pain - drug therapy
Adult
Analgesics - administration & dosage
Analgesics - therapeutic use
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Emergency
Emergency Service, Hospital
Female
Humans
Male
Pain Management - methods
Pain Measurement
Self Administration - methods
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Summary:Study objective We assess the effectiveness of patient-controlled analgesia in the emergency department (ED). We hypothesized that decline in pain intensity from 30 to 120 minutes after initial intravenous opioid administration is greater in patients receiving morphine by patient-controlled analgesia compared with usual care and would differ by a clinically significant amount. Method This was a pragmatic randomized controlled trial of patient-controlled analgesia and usual care (opioid and dose at physician’s discretion) in 4 EDs. Entry criteria included age 18 to 65 years and acute pain requiring intravenous opioids. The primary outcome was decline in numeric rating scale pain score 30 to 120 minutes postbaseline. Secondary outcomes included satisfaction, time to analgesia, adverse events, and patient-controlled analgesia pump-related problems. We used a mixed-effects linear model to compare rate of decline in pain (slope) between groups. A clinically significant difference between groups was defined as a difference in slopes equivalent to 1.3 numeric rating scale units. Results Six hundred thirty-six patients were enrolled. The rate of decline in pain from 30 to 120 minutes was greater for patients receiving patient-controlled analgesia than usual care (difference=1.0 numeric rating scale unit; 95% confidence interval [CI] 0.6 to 1.5; P
ISSN:0196-0644
1097-6760
DOI:10.1016/j.annemergmed.2017.03.064