The Journal of Bone and Joint Surgery, Vol 77, Issue 5 726-733, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Patient-controlled analgesia compared with intramuscular injection of analgesics for the management of pain after an orthopaedic procedure
CW Colwell and BA Morris
Division of Orthopaedic Surgery, Scripps Clinic and Research Foundation, La Jolla, California 92037, USA.
Patients who were scheduled for an elective joint replacement or spinal
procedure were randomly assigned prospectively to one of two groups for the
management of postoperative pain: ninety-one patients (Group I) controlled
the administration of a narcotic analgesic themselves and ninety-three
patients (Group II) received intramuscular injections of a narcotic
analgesic, as needed. The patients who controlled the analgesic used a
smaller amount of the analgesic on the first postoperative day, but the
over-all amount was not significantly different between the two groups. The
group that received intramuscular injections reported less pain overall,
according to one of three pain-assessment scales, and had more relief of
pain over-all and on the first postoperative day, according to another
scale. The patients who had had a total joint replacement and who
controlled the analgesia walked farther on the first postoperative day than
those who received intramuscular injections. There were no significant
differences between the two groups with regard to the rate of
complications, the arterial oxygen saturation levels during the first
twenty-four hours after the operation, or the length of stay in the
hospital. The nursing staff preferred the patient-administered method of
analgesia, as it necessitated equal or less nursing time to assemble,
initiate, and maintain than traditional intramuscular injections. The
average cost per patient was $58.58 for the patient-administered analgesia
and $22.45 for the intramuscular injections.(ABSTRACT TRUNCATED AT 250
WORDS)
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