TANG DH, MALONE DC.A network meta-analysis on the efficacy of serotonin type 3 receptor antagonists used in adults during the first 24 hours for postoperative nausea and vomiting prophylaxis[J].Clin Therapeutics,2012,34(2): 282-294.
With respect to PONV prophylaxis, granisetron was significantly better than ondansetron and dolasetron; ondansetron, tropisetron, and dolasetron exhibited similar efficacy. With respect to POV prophylaxis, ondansetron, granisetron, tropisetron, and dolasetron seemed to have comparable efficacy.
WU LX,DONG YP,SUNL,et al.Low concentration of dezocine in combination with morphine enhance the postoperative analgesia for thoracotomy[J].J Cardiothorac Vasc Anesth,2014,29(4):950-954.
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WANG CY,LI L Z H,SHEN B X. A multicenter randomized double-blind prospective study of the postoperative patient controlled intravenous analgesia effects of dezocine in elderly patients[J]. Int J Clin Exp Med, 2014,7(3): 530-539.
The postoperative PCIA effects of dezocine in elderly patients were determined using a large multicenter randomized double-blind prospective study.A total of 279 patients were randomized into four groups: (1) Control group (C): 2 μg/kg sufentanil plus 10 mg metoclopramide. (2) Dezocine group 1 (D1): 1 μg/kg sufentanil plus 0.1 mg/kg dezocine plus 10 mg metoclopramide. (3) Dezocine group 2 (D2): 1 μg/kg sufentanil plus 0.2 mg/kg dezocine plus 10 mg metoclopramide. (4) Dezocine group 3 (D3): 1 μg/kg sufentanil plus 0.3 mg/kg dezocine plus 10 mg metoclopramide. The index during operation including MAP, HR, SpO2, ETCO2, CVP, and BIS were determined. Analgesia effects including HR, MAP, RR, SpO2, pressing times of PCA demand, pressing times of PCR delivery, total amount of drug, additional sufentanil, VAS at rest and during moving, Ramsay sedation score, and BCS were repeated measured 1 h, 3 h, 6 h, 24 h, and 48 h after surgery. Overall satisfaction index and the side-effects including nausea, urinary retention, skin pruritus and respiratory depression were evaluated 1 h, 3 h, 6 h, 24 h, and 48 h after surgery.Dezocine combining with sufentanil is complement for sufentanil in PCIA at least in its analgesia effects after surgery. Dezocine at a dosage of 0.1 mg/kg or 0.2 mg/kg combining with sufentanil (1 μg/kg) has limited side effects as sufentanil (2 μg/kg) in PCIA. Sufentanil (1 μg/kg) combining Dezocine at a dosage of 0.1 mg/kg or 0.2 mg/kg is better than combining Dezocine at a dosage of 0.3 mg/kg in PCIA at least in Overall satisfaction index.Dezocine combining with sufentanil is a complement drug for sufentanil in PCIA. Considering the side effects and overall satisfaction index, 0.1 mg/kg seems to be an ideal dosage for Dezocine using in the postoperative PCIA in elderly patients.
Abstract Patient-controlled analgesia (PCA) is the use of a portable infusion pump activated by the patient to inject an analgesic drug intravenously, subcutaneously or epidurally. PCA permits a patient to deliver a small bolus of opioid to achieve prompt relief without over sedation. Use of PCA for pain management is increasing in hospitals and home settings, largely because it can provide equivalent or better analgesia than conventional methods, and patients are more satisfied with its use. This article reports on studies published between January 1984 and December 1995 which considered cost aspects of PCA. Most studies compared the direct costs of administering PCA with the cost of other forms of drug delivery, usually intramuscular injections. A few studies have included indirect costs such as length of stay and adverse effects associated with the use of PCA. The research on cost considerations of PCA is dominated by case reports, descriptive studies and poorly designed quasi-experimental studies. The most complete and well conducted studies usually have included only drug, equipment and labour costs. Only 6 randomised controlled trials were reported, all of which were conducted on postoperative patients. The cost effectiveness of PCA for pain management is an unresolved question because of the variability in methods used to determine costs and expenses, the different settings and patient populations in which PCA is applied, the different means to organise its management and the fact that it is a rapidly evolving technology during an era of changing reimbursement practices. There is substantial variation in the cost of drugs used in PCA and in the devices themselves, which influences the comparison of costs across studies. Also, researchers do not include the full scope of costs associated with the use of PCA in comparison with conventional drug delivery methods and some do not measure the level of pain relief achieved. Of the few complete and well designed published studies found, PCA was reported to produce superior analgesia at a higher cost than conventional intramuscular therapy in 3 studies, but to be more costly and produce less pain relief than intramuscular therapy in 1 study. There is a pressing need for cost-effectiveness, cost-utility and cost-benefit analyses to determine the appropriate clinical and cost circumstances for the use of PCA.
LANDRY GW,PARKER T. Patient controlled analgesia-a pharmacy based service[J].Hosp Pharm,1992,27(4):288,290-297.
Patient controlled analgesia (PCA) is a proven method of administering analgesics via programmable infusion devices to relieve postoperative pain and pain associated with terminal illnesses. In mid-1989, a pain management service was started in the authors' hospital by the anesthesiology service. Since pharmacists had been previously involved in PCA postoperative pain management, it was decided they would continue in that capacity with the pain management service. Responsibility for procuring, storing, and programming the pumps, as well as drug preparation and patient instruction remains an integral part of the daily operation of our pharmacy. Physician orders written by the anesthesiologists for PCA therapy are processed in the pharmacy computer. The drugs are prepared, and pumps are programmed and primed by the central intravenous (IV) admixture service. The pumps with the drugs and accessory administration set and supplies are sent to satellites where staff pharmacists aid the nurses in starting the pumps and training the patients in their correct use. All subsequent programming including dose changes, rate changes, boluses, bag changes, and problem resolution are the responsibility of the staff pharmacists. Pharmacists are periodically certified in programming skills as part of the department's quality assurance program. In 1990, over 1800 patients received the benefits of this innovative service.
The implementation and functioning of a patient-controlled analgesia (PCA) service operated by staff pharmacists are described. The pharmacy-managed PCA service was introduced into the hospital in 1988. Pharmacists initiate PCA therapy upon physician request. Standard narcotic-dosing guidelines were developed for patients receiving PCA; criteria were also developed to allow the pharmacist to adjust the narcotic dose based upon the patient's response. The dosing guidelines were approved by the pharmacy and therapeutics committee. A hospitalwide education program introduced nurses and physicians to the pharmacy-managed PCA service. Of 299 patients who received PCA therapy in 1989, more than 90% were managed by staff pharmacists. Pharmacists calculate and program initial narcotic doses and are responsible for daily patient monitoring to determine the success of therapy. Using the established guidelines, pharmacists adjust the narcotic dose based upon patient response. A quality assurance review of the PCA service has documented its safety and success. A pharmacy-managed PCA service has increased the clinical involvement of pharmacists and provided safe and effective pain management for postsurgical patients.
WONG EY,THOMPSON MV,DUDGEON MA,et al.Hospital pharmacy-based service for patient-controlled analgesia[J].Am J Hosp Pharm,1990, 47(2):364-369.
A hospital pharmacy-based patient-controlled analgesia (PCA) service is described. The pharmacy department at a 255-bed community hospital instituted a comprehensive PCA service in 1985. Pharmacists were given thorough training in the clinical aspects of pain management and were taught how to use the PCA device; nurses also received instruction. An order for PCA is issued by a physician, who may then delegate decisions about medication choice, duration of therapy, and device settings to a clinical pharmacist. The pharmacist reviews the order and evaluates the patient's status. If PCA is appropriate, the pharmacist selects the analgesic agent and PCA device settings and prepares a pharmacy monitoring card. Orders for syringes are filled in the central pharmacy or by the decentralized pharmacist. Each order is entered into the i.v. drug profile and the i.v. drug computer file, and a narcotics control card is completed. The nurse programs the device, instructs the patient, and records the patient's level of pain control on a PCA-monitoring record. The pharmacist observes patients daily and records observations and changes on the pharmacy monitoring card. Use of the PCA service has grown from an average of 56 patient days per month in 1985 to 919 in 1989, and pharmacy department revenue has increased accordingly. A moderate increase in workload has been absorbed without the need for an increase in staff. Surveys show broad acceptance of the service by physicians, nurses, and patients. A hospital pharmacy-based PCA service offered patients better control of pain, allowed pharmacists to demonstrate competence in non-distributive functions, increased the visibility of the pharmacy department, and was a source of revenue.
BERGGRENP,MATSUOKAR.Pharmacy protocol for adjusting patient-controlled analgesia[J].Hosp Pharm,1990, 25(10):928-932.
The use of patient-controlled analgesia (PCA) to manage pain post-operatively is becoming increasingly popular. The potential for pharmacist involvement is larger. Traditional areas of pharmacy involvement include PCA pump evaluation and selection, choice of narcotic-analgesic to be used, education of other health care professionals on PCA use, and development of PCA protocol guidelines. Monitoring post-operative pain and adjusting the PCA dosage are not traditional areas of pharmacist involvement. The purpose of this report is to describe a protocol which allows hospital pharmacists in an inpatient setting to adjust the PCA dose so that postoperative pain relief is maximized and sedation is minimized.
MCKENNA TR,BRANIGAN TA,SOROCKI AH.Pharmacy-initiated introduction of patient-controlled analgesia to a 400-bed community hospital[J]. Am J Hosp Pharm,1989,46(2):291-294.
ABSTRACT The pharmacist's role in the implementation of patient-controlled analgesia (PCA) in a 400-bed community hospital is described. PCA for postoperative patients was introduced on the recommendation of the pharmacy and therapeutics committee. A subcommittee selected a PCA pump, developed a physician order form and patient monitoring sheet, and in March 1987 initiated a two-month pilot study of PCA therapy in orthopedic-surgery patients. An orthopedic-service pharmacist developed an inservice-education program for the physicians, anesthesiologists, and nurses involved in the care of these patients. Because of the support of anesthesiologists for this program, PCA use during the two-month period rapidly expanded beyond orthopedics to include general and genitourinary-gynecologic patients. Nursing staff demand for PCA inservice education became so great that all staff pharmacists participated in the teaching. Pharmacists in the decentralized areas also provided one-on-one instruction to physicians, nurses, and patients. Positive evaluations of PCA therapy by patients and nurses and favorable patient pain assessment scores, in addition to the hospital-wide acceptance and use of PCA by medical staff, indicated that the program was a success. Active pharmacist participation was a major factor in PCA being well accepted by physicians, nurses, and patients as an effective alternative method of narcotic administration.
A network meta-analysis on the efficacy of serotonin type 3 receptor antagonists used in adults during the first 24 hours for postoperative nausea and vomiting prophylaxis
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2012
... 根据疼痛程度分级中的视觉模拟评分法(VAS),对使用镇痛泵的患者进行术后镇痛效果评价.0:无痛;1~3:轻度疼痛;4~6:中度疼痛;7~10:重度疼痛[2].规定平静时VAS评分0~3,治疗爆发痛有效按压比(有效按压数/总按压数)接近1表示镇痛有效,即代表镇痛满意.笔者规定有效按压比<0.8代表治疗爆发痛效果不理想,需要加用其他镇痛药物.监测心率(HR)、血压(BP)、呼吸(R)、脉搏(P)、血氧饱和度(SpO2).记录不良反应(恶心呕吐、皮肤瘙痒、尿潴留、呼吸抑制等),每天1次,观察48 h. ...
LI L Z H,SHEN B X. A multicenter randomized double-blind prospective study of the postoperative patient controlled intravenous analgesia effects of dezocine in elderly patients
