Department of Emergency Medicine, Orlando Regional Medical Center, 86 W Underwood, Orlando, FL 32806, United States of America; Department of Neurology and Neurosurgery, McGill University, 3801 Rue University, Montreal, Quebec H3A 2B4, Canada.
Department of Emergency Medicine, Orlando Regional Medical Center, 86 W Underwood, Orlando, FL 32806, United States of America.
Am J Emerg Med. 2022 Jan;51:228-238. doi: 10.1016/j.ajem.2021.10.042. Epub 2021 Nov 6.
The most common presenting complaint to the emergency department (ED) is pain. Several studies have shown that a large proportion of ED patients either receive no or sub-optimal analgesia. Patient-controlled analgesia (PCA) pumps used in the post-operative setting has shown to decrease total opioid consumption and has increased patient and nurse satisfaction.
The purpose of this systematic review was to evaluate clinical trials that have used PCAs in the ED setting, to evaluate safety and efficacy as well as patient and healthcare provider experience.
A search of PubMed, MEDLINE, and the Cochrane Database was conducted using the MESH search terms emergency department, patient-controlled analgesia, and acute pain up to September 2021. These terms were searched in all fields of publication and were limited to the English-language articles, clinical "human" studies, and studies that included the use of patient-controlled analgesia in the setting of the emergency department.
The search initially identified 227 potentially relevant articles and a total of 10 studies met criteria for inclusion. ED use of PCA therapy was associated with increased patient satisfaction, decreased pain scores, and an overall increase in opioid consumption.
The quality, the differences in study methods and outcome measures used, and heterogeneity of the studies performed to date do not provide adequate evidence to support its widespread use in the ED. Well-designed studies conducted in the ED are still needed to evaluate the ideal patient population to whom these PCAs may provide the most benefit as well as a robust cost-analysis to ensure feasibility of use in the future.
急诊科（ED）最常见的就诊主诉是疼痛。多项研究表明，很大一部分 ED 患者要么未接受镇痛治疗，要么接受的镇痛效果不佳。术后使用患者自控镇痛（PCA）泵已被证明可以减少阿片类药物的总消耗量，并提高患者和护士的满意度。
本系统评价的目的是评估在 ED 环境中使用 PCA 的临床试验，以评估其安全性和有效性以及患者和医疗保健提供者的体验。
使用 PubMed、MEDLINE 和 Cochrane 数据库，使用 MESH 搜索词“急诊科”、“患者自控镇痛”和“急性疼痛”，检索时间截至 2021 年 9 月。这些术语在所有出版领域进行了搜索，并限于英文文章、临床“人类”研究以及包括在急诊科使用患者自控镇痛的研究。
最初搜索确定了 227 篇潜在相关文章，共有 10 项研究符合纳入标准。ED 使用 PCA 治疗与患者满意度提高、疼痛评分降低以及阿片类药物总消耗量增加有关。
迄今为止进行的研究在质量、研究方法和使用的结果测量指标的差异以及异质性方面，并没有提供足够的证据支持其在 ED 中的广泛应用。仍需要在 ED 中进行精心设计的研究，以评估哪些患者人群最受益于这些 PCA，并进行稳健的成本分析，以确保未来的可行性。
