Patient-controlled intranasal analgesia (PCINA) for the management of postoperative pain: a pilot study.

STUDY OBJECTIVE

To compare patient-controlled intranasal analgesia (PCINA) for post-operative pain management with ward-provided pain therapy.

DESIGN

Randomized, prospective pilot study.

SETTING

University medical center.

PATIENTS

20 ASA status I and II orthopedic patients.

INTERVENTIONS

On the first postoperative day, 20 patients were randomized to receive either PCINA for 4 hours followed by 5 hours of ward-provided pain therapy (Group 1; n = 10) or ward-provided pain therapy for 5 hours followed by 4 hours of PCINA (Group 2; n = 10). The PCINA device used permits self-administration up to a maximum 0.025 mg dose of fentanyl every 6 minutes. Pain intensity (101-point numerical rating scale) and vital signs, as well as possible side effects, were registered at 30-minute intervals.

MEASUREMENTS AND MAIN RESULTS

Within 30 minutes after the start of PCINA, pain intensity had decreased significantly in both groups. At the 60, 150, 210, 240, 270, 390, 420, and 480 minute measuring points, there was a significant intergroup difference in pain intensity, the level being significantly lower in the PCINA period. The handling of the PCINA device presented no problem to any patient. The PCINA fentanyl requirement was 0.415 +/- 0.083 mg (Group 1) and 0.408 +/- 0.06 mg (Group 2), respectively (NS). The ward-provided pain therapy included pethidine, tramadol, metamizole, acetaminophen, codeine, and diclofenac alone or in combination. Patient satisfaction was greater with PCINA than with ward-provided pain therapy (p < 0.0005).

CONCLUSIONS

PCINA provides an adequate, noninvasive mode of postoperative pain management. The PCINA device is easy to handle and offers new perspectives in the management of postoperative pain.