Patient controlled analgesia was more effective than nurse controlled analgesia after cardiac surgery
QUESTION: In patients who have had elective coronary artery bypass grafting, is patient controlled analgesia (PCA), alone or combined with non-steroidal anti-inflammatory drugs, as effective as nurse controlled analgesia for pulmonary complications and quality of pain control?
Randomised (allocation concealed), blinded (outcome assessor), controlled trial with 3 days of follow up.
A university medical centre in Germany.
120 patients (mean age 61 y, 84% men) who had had elective coronary artery bypass grafting. Exclusion criteria were severe underlying disease, need for catecholaminergic support after extubation of the trachea, neurological deficit preventing assessment, return to the operating room, or use of antidepressants and class 1 antiarrhythmics. Follow up was complete.
Patients received education about pain assessment and use of PCA before surgery. All care except pain management was the same. After extubation, patients were allocated to PCA, PCA and indomethacin, or nurse controlled analgesia (40 in each group) for up to 3 days. Intravenous piritramide, …