Electronically monitored single-use patient-controlled analgesia pumps in postoperative pain control

Michael Zimmermann, MD, Karin Friedrich, MD, Rolf Kirchner, MD


The present study was performed to establish whether analgesic consumption in the first four postoperative hours is a suitable basis for selecting the demand dose and predicting the likely analgesic requirement over the next 20 hours with single-use patient-controlled analgesia (PCA) pumps, and to establish whether this method provides effective pain control.
Forty-two patients who had undergone a laparotic gynecological procedure (hysterectomy) were given an electronic PCA pump (Abbott Lifecare, Abbott Laboratories, Abbott Park, IL) for four hours (phase I) with a demand dose of 1 mg piritramide and a lockout period of five minutes for dose titration. Piritramide’s potency is comparable with that of morphine. The patients then received single-use PCA pumps (Baxter Infusor/Watch, Baxter, Deerfield, IL) for the next 20 hours (phase II) with a demand dose of 0.75 mg in Group A and 1.5 mg in Group B, depending on whether more or less than 10 mg pritramide had been consumed in phase I. A specially designed electronic recorder was used to measure the exact amount consumed and number of demands. Patients experiencing pain were free to receive additional piritramide at any time as rescue medication; however, these patients were withdrawn from the study.
Ninety percent of the patients in group A said they were satisfied with or undecided as to the level of analgesia. The corresponding figure in group B was 95 percent. Piritramide consumption was significantly higher in group B than in group A. There were no significant differences between the groups regarding demographic data or duration of surgery, nor did either of these two parameters affect postoperative piritramide consumption. Significant alleviation of pain and improvement in visual analog scale scores from phase I [group A, 4.7 (range, 2.0 to 6.8); group B, 4.6 (range, 3.0 to 8.3)] to phase II [group A, 3.1 (range, 0.4 to 5.2); group B, 3.2 (range, 0.4 to 6.0)] was achieved in both groups. A significant difference in analgesic consumption up to 18 hours postoperatively was seen after dose titration. In the first four hours, the rate of successful demands was significantly higher in group A (80.9 percent) than in group B (40.9 percent). The number of successful demands was comparable in the two groups during phase II (A, 98.8 percent; B, 94.5 percent).
In summary, total opioid consumption during the first four hours after operation showed two groups of patients with significantly different needs for piritramide (< 10 mg per 4 hours or > 10 mg per 4 hours). Two different dose regimes were applied using a high and a low bolus size in the following 20 hours. We concluded that effective pain control without respiratory depression was achieved with single-use PCA pumps. Opioid consumption varied significantly, whereas pain levels did not.


postoperative analgesia, patient-controlled analgesia, single-use, demand-dose, acute analgesia

Full Text:



Jage J, Hartje H: Postoperative schmerztherapie. Anaesthesist. 1997; 46: 65-77.

Lehmann KA (Ed.): Patientenkontrollierte analgesie. In: Der Postoperative Schmerz, 2nd ed. Berlin: Springer-Verlag, 1994: 317-355.

Wulf H, Neugebauer E, Maier CH (Eds.): Die Behandlung Akuter Perioperativer und Posttraumatischer Schmerzen. Stuttgart: Thieme Verlag, 1997.

Irwin M, Gillespie JA, Morton NS: Evaluation of a disposable patient-controlled analgesia device in children. Br J Anaesth. 1992; 68: 411-413.

Sümpelmann R, Schröder D, Krohn S, et al.: Patient-enkontrollierte analgesie bei kindern. Anasth Intensivmed. 1996; 37: 19-26.

Sittl R, Tillig J, Huber H, et al.: Schmerztherapie bei kindern und erwachsenen nach trichterbrustkorrektur. Der Schmerz. 1995; 9: 179-184.

Ure BM, Neugebauer E, Ullmann K, et al.: Patient-enkontrollierte analgesie. Chirurg. 1993; 64: 802-808.

Lehmann KA, Henn C: Zur lage der postoperativen schmerztherapie in der Bundesrepublik Deutschland: Ergebnisse einer repräsentativumfrage. Anaesthesist. 1987; 36: 400-406.

The Royal College of Surgeons of England, The College of Anaesthesists Commission of the Provision of Surgical Services: Report of the working party on pain after surgery. London: Royal College of Surgeons, 1990.

Apfelbaum JL Chen C, Metha SS, et al.: Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97(2): 534-540.

Chung JW, Lui JC: Postoperative pain management: Study of patients’ level of pain and satisfaction with health care providers’ responsiveness to their reports of pain. Nurs Health Sci. 2003; 5(1): 13-21.

Rocchi A, Chung F, Forte L: Canadian survey of postsurgical pain and pain medication experiences. Can J Anaesth. 2002; 49(10): 1053-1056.

Huang N, Cunningham F, Laurito CE, et al.: Can we do better with postoperative pain management? Am J Surg. 2001; 182(5): 440-448.

Vallano A, Aguilera C, Arnau JM, et al.: Management of postoperative pain in abdominal surgery in Spain: A multicentre drug utilization study. Br J Clin Pharmacol. 1999; 47(6): 667-673.

Beauregard L, Pomp A, Choiniere M: Severity and impact of pain after day-surgery. Can J Anaesth. 1998; 45(4): 304-311.

Rowbotham DJ, Wyld R, Nimmo WS: A disposable device for patient-controlled anagesia with fentanyl. Anaesthesia. 1989; 44: 922-944.

Sawaki Y, Parker RK, White PF: Patient and nurse evaluation of patient controlled analgesia delivery systems for postoperative pain management. J Pain Symptom Manage. 1992; 7: 443-453.

Owen H, Plummer J, Ilsley R, et al.: Variable-dose patientcontrolled analgesia. Anaesthesia. 1995; 50: 855-857.

Lehmann KA: Systemische postoperative schmerztherapie. Anaesthesist. 1992; 40(Suppl): 44.

Means LJ, Allen HM, Lookabill SJ, et al.: Recovery room initiation of patient-controlled analgesia in pediatric patients. Anaesthesiology. 1988; 29: 112.

Lehmann KA: Gedanken zur postoperativen schmerztherapie. Dtsch Krankenpflegez. 1986; 39: 146-152.

Etches RC: Respiratory depression associated with patientcontrolled analgesia: A review of eight cases. Can J Anaesth. 1994; 41: 125-132.

Jage J: Welche Organisationsstruktur ist zur Durchführung einer patientenkontrollierten oder kontinuierlichen Opioid-analgesie auf Normalstation notwendig. Anaesthesist 1996; 45(Suppl 3): 74-75.

Maier C, Wulf H: Organisation der perioperativen Schmerztherapie. In Lehmann KA (Ed.): Der Postoperative Schmerz, 2nd ed. Berlin: Springer Verlag, 1994: 683-7022.

Maier CH: Auswirkungen eines Akutschmerzdienstes auf die Effektivität und die Komplikationen einer Schmerztherapie auf allgemeinen Pflegestationen. Anaesthesist. 1996; 45 [Suppl 3]:78-79.

Parker R, Holtmann B, White PF: Effects of a nighttime opioid infusion with PCA therapy on patient comfort and analgesic requirements after abdominal hysterectomy. Anesthesiology. 1992; 76: 362-367.

Schug SA, Torrie JJ: Safety assessment of postoperative pain management by an acute pain service. Pain. 1993; 55: 387-391.

Ginsberg B, Gil KM, Muir M, et al.: The influence of lockout intervals and drug selection on patient-controlled analgesia following gynecological surgery. Pain. 1995; 62: 95-100.

Gust R, Weber A, Henn-Beilharz A, et al.: Patient-enkontrollierte Analgesie (PCA) nach urologischen Eingriffen. Anaesthesiol Reanimat. 1995; 20: 134-138.

McQuay HJ, Jadad AR, Caroll D: Scientific aspects of patientcontrolled analgesia. In Lehmann KA, Klaschik E (Eds.): On-Demand Analgesie. Wiesbaden, Germany: Wissenschaftliche, Verlagsabteilung, Abbott, 1991: 84-94.

Robinson SL, Rowbotham DJ, Mushambi M: Electronic and disposable patient-controlled analgesia systems. Anaesthesia. 1992; 47: 161-163.

Wermeling P, Foster TS, Rapp RP, et al.: Evaluation of a disposable, nonelectronic, patient-controlled-analgesia device for postoperative pain. Clin Pharm. 1987; 6: 307-314.

Breitfeld C, Peters J, Vockel T, et al.: Emetic effects of morphine and piritramide. Br J Anaesth. 2003; 91(2): 218-223.

Lehmann KA: Mit der Loading-dose den Schmerz titriert bekämpfen. Therapiewoche. 1991; 41: 21.

Chang AM, Ip WY, Cheung TH: Patient-controlled analgesia versus conventional intramuscular injection: A cost effectiveness analysis. J Adv Nurs. 2004; 46(5): 531-541.

DOI: https://doi.org/10.5055/jom.2005.0056


  • There are currently no refbacks.