Ballantyne J C, Carr D B, Chalmers T C, Dear K B, Angelillo I F, Mosteller F
Department of Anesthesia, Massachusetts General Hospital, Boston 02114.
J Clin Anesth. 1993 May-Jun;5(3):182-93. doi: 10.1016/0952-8180(93)90013-5.
To compare outcomes during conventional analgesia (as-needed intramuscular dosing) and patient-controlled analgesia (PCA) in postoperative patients by analyzing data from published comparative trials.
Meta-analyses of 15 randomized control trials.
Seven hundred eighty-seven adult patients (aged 16 to 65) undergoing various operative procedures.
Either PCA or conventional analgesia for postoperative pain control.
Data were extracted on analgesic efficacy, analgesic use, patient satisfaction, length of hospital stay, and side effects. Meta-analyses of the data showed the following: (1) greater analgesic efficacy when PCA was used, with a mean additional benefit of 5.6 on a scale of 0 to 100 (SED, 2.2; p = 0.006); (2) a nonsignificant trend toward reduced analgesic use in PCA patients, based on a count of trials finding in one direction or the other (p = 0.092); (3) a 42% difference in the proportion of patients expressing satisfaction over dissatisfaction (SED, 20%; p = 0.02), with PCA being preferred; (4) a nonsignificant trend toward shortening of length of hospital stay with PCA use (mean, 0.15 days, SED, 0.13; p = 0.24); (5) no significant differences in the occurrence of any side effect.
Patient preference strongly favors PCA over conventional analgesia. Patients using PCA also obtain better pain relief than those using conventional analgesia, without an increase in side effects. Favorable effect of PCA upon analgesic usage and length of hospital stay did not in the initial trials attain statistical significance. Nonetheless, the favorable trends in the mean effect sizes for both outcomes argue that further studies of both outcomes should be performed to determine whether the favorable impact of PCA upon either may become statistically significant if larger numbers of patients are enrolled.
通过分析已发表的比较试验数据，比较术后患者采用传统镇痛方法（按需肌内注射给药）和患者自控镇痛（PCA）的效果。
对15项随机对照试验进行荟萃分析。
787例成年患者（年龄16至65岁），接受各种手术操作。
采用PCA或传统镇痛方法控制术后疼痛。
提取了有关镇痛效果、镇痛药物使用、患者满意度、住院时间和副作用的数据。对数据进行荟萃分析显示如下结果：（1）使用PCA时镇痛效果更佳，在0至100分的量表上平均额外获益为5.6分（标准误，2.2；p = 0.006）；（2）基于在某一方向或另一方向有结果的试验计数，PCA患者的镇痛药物使用有减少的趋势，但无统计学意义（p = 0.092）；（3）表示满意与不满意的患者比例相差42%（标准误，20%；p = 0.02），患者更倾向于PCA；（4）使用PCA有缩短住院时间的趋势，但无统计学意义（平均缩短0.15天，标准误，0.13；p = 0.24）；（5）在任何副作用的发生方面无显著差异。
患者明显更倾向于PCA而非传统镇痛方法。使用PCA的患者比使用传统镇痛方法的患者疼痛缓解更好，且副作用未增加。PCA在镇痛药物使用和住院时间方面的有利影响在最初试验中未达到统计学意义。尽管如此，这两个结果的平均效应量的有利趋势表明，应针对这两个结果进行进一步研究，以确定如果纳入更多患者，PCA对二者的有利影响是否会具有统计学意义。
