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Emerging treatment modalities: Balancing efficacy and safety
The advantages and disadvantages of intravenous patient-controlled analgesia (i.v. PCA) and epidural analgesia are discussed. New approaches to the management of patients with acute post-operative pain are described. The results of controlled clinical trials with these modalities are presented. Intr...
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Published in: | American journal of health-system pharmacy 2007-03, Vol.64 (6 Supplement 4), p.S6-S11 |
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Main Author: | |
Format: | Article |
Language: | English |
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Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | The advantages and disadvantages of intravenous patient-controlled analgesia (i.v. PCA) and epidural analgesia are discussed. New approaches to the management of patients with acute post-operative pain are described. The results of controlled clinical trials with these modalities are presented.
Intravenous patient-controlled analgesia, while effective, is a burdensome technology requiring approximately 125 steps and at least 6 staff members. Furthermore, medication and pump programming errors may lead to patient injury. Epidural analgesia via catheter has a high reported failure rate, causing analgesic gaps and requiring a high level of staff intervention. In a clinical trial involving hip arthroplasty, extended-release epidural morphine demonstrated a 48-hour duration of action with a marked reduction in need for supplemental analgesia. The fentanyl Iontophoretic Transdermal System has demonstrated therapeutic equivalence with morphine intravenous patient-controlled analgesia and similar safety. Selective opioid antagonists are under development that may selectively block gastrointestinal opioid receptors while preserving analgesia.
Recently approved agents and those in development may address a variety of unmet needs in the management of patients with post-operative pain. |
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ISSN: | 1079-2082 1535-2900 |
DOI: | 10.2146/ajhp060680 |