Self-Administered Versus Nurse Administered Pain Medication. Clinical Trial
Official title:
Patient Controlled Oral Analgesia (PCOA) for Postoperative Pain Management After Total Knee Replacement-A Pilot Study
Patient Centered Care (PCC) is "an approach that consciously adopts the patient's
perspective...about what matters" (Gerteis, Edgeman, Levitan, Walker, Stokes, Cleary,
Delbanco, 1993). Experiencing pain is the most common concern of patients before surgery -
even ahead of whether the surgery would improve their condition (Apfelbaum, 2003). Current
standard of practice for post-operative pain management in most acute care hospitals today
is intravenous patient controlled analgesia (IV PCA). However, despite the fact that
patients prefer IV PCA because it affords them greater control and provides them with better
pain relief (Ballantyne, Carr, deFerranti, Suarez, Lau, Chalmers, Angelillo, Mosteller, 1998
; Rawal, 2001), hospitals routinely take control of pain medications away from patients once
they are switched to pain tablets. Patients must then wait, in pain, for their nurse to
bring them pain tablets.
Patient controlled oral analgesia (PCOA) has been utilitzed in several centers in the US and
Germany. Preliminary evidence from the literature seems to indicate that the benefits of
PCOA are similar to IV PCA including increased patient satisfaction and better pain control
(Striebel, Romer, Kopf, Schwagmeier ,1996; Striebel, Scheitza, Philippi, Behrens, Toussaint,
1998). At the Toronto Western Hospital, University Health Network, we have successfully
implemented a PCOA program on two surgical units (Orthopedics/Rheumatology and Spinal). The
purpose of this study is to compare usual nurse administered oral analgesia to PCOA with
respect to pain, patient satisfaction, and passive range of knee motion in postoperative
total knee replacement patients.
n/a
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment