The amount of morphine administered per patient, for postoperative pain, using a Patient-Controlled Analgesia (PCA) device: at Universitas Academic Hospital, Bloemfontein, from January 2015 to December 2017
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Date
2020-12
Authors
Kotze, George Petrus Johannes
Journal Title
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Publisher
University of the Free State
Abstract
Background: Intravenous morphine patient-controlled analgesia (PCA) is one of the modalities used by anaesthesiologists to treat patients after operation for acute postoperative pain. About 50% of patients experience inadequate pain control post-surgery when treated with traditional intramuscular (IM) opioids prescribed pro re nata (PRN). Patient-controlled analgesia can also be used to treat patients with chronic pain conditions, advanced metastatic cancer, and in pregnant patients during normal vaginal delivery. The development of intravenous morphine patient-controlled analgesia has led to more effective management of acute postoperative pain, especially in older patients with more comorbid conditions, where a more controlled administration of opioid analgesia is preferred. Other modalities of pain management, like neuraxial and regional analgesia techniques also provide efficacious control of post-surgical pain versus morphine PCA. These techniques are sometimes difficult to perform and contraindicated in patients taking anticoagulation therapy or patients with pre-existing neurological deficits. Intravenous morphine patient-controlled analgesia remains the gold standard for treating pain in these patients. Objectives: The aim and primary objective of the study was to determine how many intravenous (IV) morphine is being used via intravenous morphine patient-controlled analgesia at Universitas Academic Hospital per patient over a 24-hour period and to determine the amount of morphine unused and discarded as wastage. Methods: A retrospective study was conducted including all adult patients that underwent surgery and received intravenous morphine patient-controlled analgesia at Universitas Academic Hospital in Bloemfontein from 2015 to 2017. Data related to morphine PCA usage and presence of side-effects were collected from the PCA record form which is kept in the patient’s file after discharge. Results: A total of 155 patients who received intravenous morphine patient-controlled analgesia after surgery were included in the study. The median age were 55 years with 48.6% female patients and 51.4% male. The median total dosage of morphine received per patient was 22.75 mg over 24 hours. The median volume of morphine solution discarded per patient was 60 ml. Morphine PCA was mostly used for neurosurgical procedures (28.2%), followed by general surgery (20.8%), and orthopaedic surgery (16.1%). 86.9% of patients reported sufficient analgesia with intravenous morphine patient-controlled analgesia and 77.8% of patients did not require breakthrough pain medication. The intravenous morphine PCA device was used with insight by 76.5% of patients. Only 53.6% of the PCA record forms were assessed as correct and completely documented. Conclusion: This study found that the average total dosage of morphine being used per patient receiving intravenous morphine patient-controlled analgesia was 22.75 mg over a 24-hour period. This is much less than the 90 mg morphine solution being used in the morphine PCA pump. A large volume of morphine gets discarded as wastage. We recommend reviewing the intravenous morphine PCA protocol of Universitas Academic Hospital to decrease unnecessary morphine wastage. Further research opportunities include a cost analysis study of intravenous morphine PCA usage per patient at Universitas Academic Hospital.
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Keywords
Dissertation (M.Med (Anaesthesiology))--University of the Free State, 2020, Analgesia, Intramuscular, Intravenous, Local anesthetics, Morphine, Opioids, Pain control, Pain pump, Patient-controlled analgesia