Satisfaction with epidural and intravenous patient-controlled analgesia

Allen H. Lebovits, Panagiotis Zenetos, Daniel K. O'Neill, Donna Cox, Michel Y. Dubois, Lynn Jansen, Herman Turndorf

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective. Postoperative intravenous (IV) versus epidural morphine patient-controlled analgesia (PCA) were compared regarding maintenance of initial PCA route, pain levels, side effects, and levels of satisfaction. Additionally, the role of preoperative attitudinal expectations in predicting postoperative levels of satisfaction with pain management as well as maintenance of initial PCA route was evaluated. Design. After either abdominal or thoracic surgery, 70 eligible patients were randomized to receive morphine either through an epidural route (n = 37) or an intravenous PCA pump (n = 33). Setting. A large tertiary university teaching hospital in a major northeastern city. Outcome measures. Patients completed visual analogue rating scales 1 week before surgery regarding attitudes such as expectations of satisfaction with pain management after surgery and expectations of medication efficacy postsurgically. Postoperatively, beginning the day after surgery, patients were asked to complete visual analogue rating scales every 12 hours until they were discharged, for a maximum of 3 postoperative days. The scales evaluated included pain, ability to think, and satisfaction with pain control. Results. There were no significant between-group differences on the postoperative visual analogue scales. Although the overall rate of changing the initial PCA route to which the patients were randomized was identical for both groups (30%), those patients who had thoracic surgery changed their route of PCA administration significantly less when their initial PCA route was epidural (20%) than when their initial PCA route was IV (46%) (P <.05). Patients who were satisfied with pain control postoperatively were more likely to have been started on IV PCA (P = .001), have lower preoperative expectations of postoperative satisfaction with pain (P <.001), and have higher preoperative expectations of medication effects on postoperative pain (P <.001). Additionally, older patients (P = .007) and patients with lower preoperative expectations of postoperative satisfaction with pain (P = .003) were more likely to adhere to their initial treatment protocol. Conclusions. Both techniques, IV and epidural PCA, result in high levels of satisfaction. Satisfaction with PCA can be accurately predicted in nearly three of four patients based on initial PCA route and preoperative attitudes. Additionally, maintaining the initial treatment plan can be accurately predicted based on age and preoperative attitudes. Patient expectations about pain relief should be addressed preoperatively, particularly with younger patients, for optimal results.

Original languageEnglish (US)
Pages (from-to)280-286
Number of pages7
JournalPain Medicine
Volume2
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Patient-Controlled Analgesia
Pain
Visual Analog Scale
Pain Management
Morphine
Thoracic Surgery
Maintenance
Aptitude
Epidural Analgesia
Clinical Protocols
Postoperative Pain
Ambulatory Surgical Procedures
Tertiary Care Centers
Teaching Hospitals

Keywords

  • PCA
  • Postoperative satisfaction
  • Preoperative expectations

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Lebovits, A. H., Zenetos, P., O'Neill, D. K., Cox, D., Dubois, M. Y., Jansen, L., & Turndorf, H. (2001). Satisfaction with epidural and intravenous patient-controlled analgesia. Pain Medicine, 2(4), 280-286. https://doi.org/10.1046/j.1526-4637.2001.01051.x

Satisfaction with epidural and intravenous patient-controlled analgesia. / Lebovits, Allen H.; Zenetos, Panagiotis; O'Neill, Daniel K.; Cox, Donna; Dubois, Michel Y.; Jansen, Lynn; Turndorf, Herman.

In: Pain Medicine, Vol. 2, No. 4, 2001, p. 280-286.

Research output: Contribution to journalArticle

Lebovits, AH, Zenetos, P, O'Neill, DK, Cox, D, Dubois, MY, Jansen, L & Turndorf, H 2001, 'Satisfaction with epidural and intravenous patient-controlled analgesia', Pain Medicine, vol. 2, no. 4, pp. 280-286. https://doi.org/10.1046/j.1526-4637.2001.01051.x
Lebovits, Allen H. ; Zenetos, Panagiotis ; O'Neill, Daniel K. ; Cox, Donna ; Dubois, Michel Y. ; Jansen, Lynn ; Turndorf, Herman. / Satisfaction with epidural and intravenous patient-controlled analgesia. In: Pain Medicine. 2001 ; Vol. 2, No. 4. pp. 280-286.
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abstract = "Objective. Postoperative intravenous (IV) versus epidural morphine patient-controlled analgesia (PCA) were compared regarding maintenance of initial PCA route, pain levels, side effects, and levels of satisfaction. Additionally, the role of preoperative attitudinal expectations in predicting postoperative levels of satisfaction with pain management as well as maintenance of initial PCA route was evaluated. Design. After either abdominal or thoracic surgery, 70 eligible patients were randomized to receive morphine either through an epidural route (n = 37) or an intravenous PCA pump (n = 33). Setting. A large tertiary university teaching hospital in a major northeastern city. Outcome measures. Patients completed visual analogue rating scales 1 week before surgery regarding attitudes such as expectations of satisfaction with pain management after surgery and expectations of medication efficacy postsurgically. Postoperatively, beginning the day after surgery, patients were asked to complete visual analogue rating scales every 12 hours until they were discharged, for a maximum of 3 postoperative days. The scales evaluated included pain, ability to think, and satisfaction with pain control. Results. There were no significant between-group differences on the postoperative visual analogue scales. Although the overall rate of changing the initial PCA route to which the patients were randomized was identical for both groups (30{\%}), those patients who had thoracic surgery changed their route of PCA administration significantly less when their initial PCA route was epidural (20{\%}) than when their initial PCA route was IV (46{\%}) (P <.05). Patients who were satisfied with pain control postoperatively were more likely to have been started on IV PCA (P = .001), have lower preoperative expectations of postoperative satisfaction with pain (P <.001), and have higher preoperative expectations of medication effects on postoperative pain (P <.001). Additionally, older patients (P = .007) and patients with lower preoperative expectations of postoperative satisfaction with pain (P = .003) were more likely to adhere to their initial treatment protocol. Conclusions. Both techniques, IV and epidural PCA, result in high levels of satisfaction. Satisfaction with PCA can be accurately predicted in nearly three of four patients based on initial PCA route and preoperative attitudes. Additionally, maintaining the initial treatment plan can be accurately predicted based on age and preoperative attitudes. Patient expectations about pain relief should be addressed preoperatively, particularly with younger patients, for optimal results.",
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AU - Cox, Donna

AU - Dubois, Michel Y.

AU - Jansen, Lynn

AU - Turndorf, Herman

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N2 - Objective. Postoperative intravenous (IV) versus epidural morphine patient-controlled analgesia (PCA) were compared regarding maintenance of initial PCA route, pain levels, side effects, and levels of satisfaction. Additionally, the role of preoperative attitudinal expectations in predicting postoperative levels of satisfaction with pain management as well as maintenance of initial PCA route was evaluated. Design. After either abdominal or thoracic surgery, 70 eligible patients were randomized to receive morphine either through an epidural route (n = 37) or an intravenous PCA pump (n = 33). Setting. A large tertiary university teaching hospital in a major northeastern city. Outcome measures. Patients completed visual analogue rating scales 1 week before surgery regarding attitudes such as expectations of satisfaction with pain management after surgery and expectations of medication efficacy postsurgically. Postoperatively, beginning the day after surgery, patients were asked to complete visual analogue rating scales every 12 hours until they were discharged, for a maximum of 3 postoperative days. The scales evaluated included pain, ability to think, and satisfaction with pain control. Results. There were no significant between-group differences on the postoperative visual analogue scales. Although the overall rate of changing the initial PCA route to which the patients were randomized was identical for both groups (30%), those patients who had thoracic surgery changed their route of PCA administration significantly less when their initial PCA route was epidural (20%) than when their initial PCA route was IV (46%) (P <.05). Patients who were satisfied with pain control postoperatively were more likely to have been started on IV PCA (P = .001), have lower preoperative expectations of postoperative satisfaction with pain (P <.001), and have higher preoperative expectations of medication effects on postoperative pain (P <.001). Additionally, older patients (P = .007) and patients with lower preoperative expectations of postoperative satisfaction with pain (P = .003) were more likely to adhere to their initial treatment protocol. Conclusions. Both techniques, IV and epidural PCA, result in high levels of satisfaction. Satisfaction with PCA can be accurately predicted in nearly three of four patients based on initial PCA route and preoperative attitudes. Additionally, maintaining the initial treatment plan can be accurately predicted based on age and preoperative attitudes. Patient expectations about pain relief should be addressed preoperatively, particularly with younger patients, for optimal results.

AB - Objective. Postoperative intravenous (IV) versus epidural morphine patient-controlled analgesia (PCA) were compared regarding maintenance of initial PCA route, pain levels, side effects, and levels of satisfaction. Additionally, the role of preoperative attitudinal expectations in predicting postoperative levels of satisfaction with pain management as well as maintenance of initial PCA route was evaluated. Design. After either abdominal or thoracic surgery, 70 eligible patients were randomized to receive morphine either through an epidural route (n = 37) or an intravenous PCA pump (n = 33). Setting. A large tertiary university teaching hospital in a major northeastern city. Outcome measures. Patients completed visual analogue rating scales 1 week before surgery regarding attitudes such as expectations of satisfaction with pain management after surgery and expectations of medication efficacy postsurgically. Postoperatively, beginning the day after surgery, patients were asked to complete visual analogue rating scales every 12 hours until they were discharged, for a maximum of 3 postoperative days. The scales evaluated included pain, ability to think, and satisfaction with pain control. Results. There were no significant between-group differences on the postoperative visual analogue scales. Although the overall rate of changing the initial PCA route to which the patients were randomized was identical for both groups (30%), those patients who had thoracic surgery changed their route of PCA administration significantly less when their initial PCA route was epidural (20%) than when their initial PCA route was IV (46%) (P <.05). Patients who were satisfied with pain control postoperatively were more likely to have been started on IV PCA (P = .001), have lower preoperative expectations of postoperative satisfaction with pain (P <.001), and have higher preoperative expectations of medication effects on postoperative pain (P <.001). Additionally, older patients (P = .007) and patients with lower preoperative expectations of postoperative satisfaction with pain (P = .003) were more likely to adhere to their initial treatment protocol. Conclusions. Both techniques, IV and epidural PCA, result in high levels of satisfaction. Satisfaction with PCA can be accurately predicted in nearly three of four patients based on initial PCA route and preoperative attitudes. Additionally, maintaining the initial treatment plan can be accurately predicted based on age and preoperative attitudes. Patient expectations about pain relief should be addressed preoperatively, particularly with younger patients, for optimal results.

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