Patient controlled analgesia improves pain management following abdominal surgery.

Abstract

Background: Due to the increasing number of abdominal surgeries performed each year a protocol needs to be introduced to help patients experience more effective pain management. Aim: The purpose of this study is to evaluate the most effective pain management when comparing PCA with IM analgesia after major abdominal surgery. Search Strategy: A search was conducted for best quality literature using various databases, these included the Cumulative Index to Nursing and Allied Healthcare Literature (CINAHL), Academic Search Complete, Google scholar and the Cochrane database of systemic reviews (CDSR). Six of the key words inserted during the literature search include : ' PCA', 'abdominal surgeries', 'intramuscular', 'pain', 'PCA vs intramuscular', 'intramuscular injections'. Methods used: This focused on studies which used randomized controlled trials (RCT's) and Meta-analysis as their basis. This study selected full text articles which were published in English, comparing the efficacy of PCA with IM analgesia only. Studies which included patients with chronic pain, children (below the age of 18) or disabled persons were excluded from the study. Studies which did not make a comparison between the two factors under investigation (PCA & IM) were also excluded. In all the studies, the pain levels experienced by participants were recorded using the visual analogue scale (V AS). To analyze the studies retrieved two critical appraisal skills programme (CASP) created by the public health resource unit were used. Overall findings: Six studies were undertaken researching a total of 4271 patients. Participants were randomized in two groups, 2239 patients received PCA while 2032 patients who were administered IM analgesia. PCA provided better effective pain management and greater patient satisfaction than IM analgesia (p < 0.001). PCA patients in Hudcova et al. (2011) achieved lower points on the VAS (VAS score 3) compared to the control group (VAS score 13). This study has found that patients see PCA as the most effective method of analgesia after abdominal surgery. Recommendations and implications for practice: This study suggests that Malta should focus in shifting towards PCA. Further research is still required to strengthen the already available evidence and help to create awareness among the general public and to inform the stake holders with such evidence.