The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA
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J. Erlenwein1 · M. I. Emons1 · F. Petzke1 · M. Quintel1 · I. Staboulidou2 · M. Przemeck3 1
Department of Anesthesiology, University Hospital, Georg August University of Göttingen, Göttingen, Germany 2 Fetal Medicine Center Hannover, Hannover, Germany 3 Department of Anesthesiology and Intensive Care, Annastift, Hannover, Hannover, Germany
© The Author(s) 2020
The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA A cohort analysis
Background Caregivers have focused on improvement in postoperative pain management for several years; however, for some areas quality of pain management remains inadequate [1, 22]. Previous surveys found that patients undergoing procedures without the use of advanced analgesia concepts, such as peripheral pain catheters, or epidural analgesia, are more likely to suffer from insufficient pain relief [13, 22]. Since patients with peripheral pain catheters or neuraxial analgesia are commonly monitored by an acute pain service (APS) and patients without are not, this could be a potential explanation for the observed differences. For practical and economic reasons, the involvement of an APS for all patients seems challenging and might not be necessary [19, 20, 36]. Novel approaches and concepts to supplement an APS are therefore of great interest and potential impact [10, 20, 34]. Standard protocols or algorithms, which enable regular nursing floor staff to react to the patients’ needs, including an adequate response to an acute increase in pain, are considered essential to ensure sufficient analgesia [10, 27]. Despite significant heterogeneity, these concepts typically include instructions for a rescue medication to be administered in cases of insufficient pain relief [2, 5, 6, 14, 15,
18, 27, 32, 35]. Germany has widely adopted protocols including oral opioids for rescue medication [6]. Ease of administration and independence from any sort of catheter or device, thought to impair the patients’ mobilization or mobility, are obvious advantages of this approach. Despite the widespread adoption of protocols including oral opioids as rescue medication in most German hospitals, the effectiveness of such protocols has only been evaluated longitudinally in a before and after setting, meaning before and after their implementation within a clinical setting [2, 3, 5, 6, 9, 14, 15, 18, 27, 32, 35]. Patient-controlled intravenous analgesia (PCIA) has been the technique of choice for comparisons for years and is still considered the gold standard [21].
Objective The aim of this analysis was to compare the effectiveness of a standardized algorithm to control the process of application of rescue medication based on oral short-acting opioids to the administration of short-acting opioids via patientcontrolled intravenous analgesia (PCIA).
Material and methods Study cohorts In this analysis of two cohorts of previously conducted prospective, observational trials we compared the effectiveness of a standardized algorithm based on an oral short-acting opioid pos
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