Viscusi Eugene R
Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Am J Health Syst Pharm. 2007 Mar 15;64(6 Suppl 4):S6-S11. doi: 10.2146/ajhp060680.
The advantages and disadvantages of intravenous patient-controlled analgesia (i.v. PCA) and epidural analgesia are discussed. New approaches to the management of patients with acute post-operative pain are described. The results of controlled clinical trials with these modalities are presented.
Intravenous patient-controlled analgesia, while effective, is a burdensome technology requiring approximately 125 steps and at least 6 staff members. Furthermore, medication and pump programming errors may lead to patient injury. Epidural analgesia via catheter has a high reported failure rate, causing analgesic gaps and requiring a high level of staff intervention. In a clinical trial involving hip arthroplasty, extended-release epidural morphine demonstrated a 48-hour duration of action with a marked reduction in need for supplemental analgesia. The fentanyl Iontophoretic Transdermal System has demonstrated therapeutic equivalence with morphine intravenous patient-controlled analgesia and similar safety. Selective opioid antagonists are under development that may selectively block gastrointestinal opioid receptors while preserving analgesia.
Recently approved agents and those in development may address a variety of unmet needs in the management of patients with post-operative pain.
