Impact of Patient-Controlled Analgesia on Patient's Satisfaction after Coronary Artery Bypass Surgery: A Randomized Clinical Trial.

Abstract

Abstract: Introduction: Pain has been pointed out as one of the concerns of cardiac surgery patients. Nurses often underestimate patient's pain and patients generally receive inadequate analgesia. Acute pain management has been a challenge for health professionals and several regiments have been described. We designed this study to evaluate the effectiveness of pain control with IV patient-controlled analgesia (IV PCA) versus conventional nurse-controlled analgesia (NCA) after coronary artery bypass graft (CABG) surgery on patient's satisfaction during the postoperative period in the intensive care unit (ICU). Methods: In this randomized clinical trial, 80 patients undergone first –time elective CABG enrolled by convenience sampling and were randomly allocated to two groups to receive either PCA or NCA. PCA plus continuous infusion of morphine started immediately after transferring the patients to the ICU. NCA was based on intravenous injections of morphine on demand (PRN). Pain was assessed using a verbal rating scale (VRS). Sedation level and morphine consumption were evaluated from extubation until 48 hours after surgery also patient's satisfaction was assessed using pain treatment satisfaction scale (PTSS) and nurses opinion of PCA method were obtained. Data were analyzed using SPSS17. Results: VRS scores were higher in the NCA group compared to the PCA group [3.27 (1.17) vs. 0.75 (0.66); p < 0.001]. Morphine consumption was significantly higher in the PCA group compared to the NCA group [28.43 (7.15) mg vs. 8.37 (5.36) mg; p < 0.001]. Patients satisfaction was higher in the PCA group compared to the NCA group (p<0.001) also nurses opinion were somewhat agree with the PCA method .PCA was safe and respiratory depression was not observed in any of the subjects. Mean sedation scores did not differ between the two groups. Conclusion: PCA with background infusion of morphine increases morphine consumption and improves pain relief, without increasing side effects. It appears to be superior to NCA and can be recommended for patients after CABG surgery.