Patient-controlled versus scheduled, nurse-administered analgesia following vaginal reconstructive surgery: a randomized trial

• Published in: American journal of obstetrics and gynecology 2012-11, Vol.207 (5), p.433.e1-433.e6
• Main Authors: Crisp, Catrina C., MD, Bandi, Sindura, MD, Kleeman, Steven D., MD, Oakley, Susan H., MD, Vaccaro, Christine M., DO, Estanol, Maria V., MD, Fellner, Angela N., PhD, Pauls, Rachel N., MD
• Format: Article
• Language: English
• Subjects: Aged; Analgesia - nursing; Analgesia, Patient-Controlled - methods; Analgesics, Opioid - administration & dosage; Biological and medical sciences; Female; Gynecologic Surgical Procedures - methods; Gynecology. Andrology. Obstetrics; Humans; Hydromorphone - administration & dosage; intravenous analgesia; Length of Stay; Medical sciences; Middle Aged; Obstetrics and Gynecology; pain control; Pain Measurement; Pain, Postoperative - drug therapy; Patient Satisfaction; patient-controlled analgesia (PCA); postoperative analgesia; Postoperative Complications - chemically induced; Vagina - surgery; vaginal surgery
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2012.06.040

Objective To determine whether patient-controlled analgesia or scheduled intravenous analgesia provides superior pain relief and satisfaction with pain control after vaginal reconstructive surgery. Study Design Fifty-nine women scheduled for vaginal reconstructive surgery were enrolled in this randomized trial. Operative procedures and postoperative orders were standardized. Visual analog scales for pain and satisfaction with pain control were recorded during the hospital stay and 2 weeks after surgery. Results Patients receiving patient-controlled analgesia had less pain on postoperative day 1, 25 mm vs 39 mm, on visual analog scales ( P = .007). Although this group used twice as much hydromorphone (3.57 mg vs 1.48 mg, P < .001), there was no difference in side effects, length of hospital stay, or complications. For the sample overall, larger amounts of narcotic used correlated with higher pain scores (r = 0.364, P = .009) and worse satisfaction scores (r = −0.348, P = .012). Conclusion In patients undergoing vaginal surgery, patient-controlled analgesia offers superior pain relief on postoperative day 1 when compared with scheduled, nurse-administered hydromorphone.