Patientenkontrollierte Analgesie zur Behandlung postoperativer Schmerzen :Herausforderungen und Innovationen
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Philipps-Universität Marburg
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Abstract
Patient-controlled analgesia is a common principle in postoperative pain management.
Since its early beginnings in the late seventies of the last century the main principle of
patient-controlled analgesia has stayed the same: The patient controls his own pain
therapy and determines frequency and time of application. Nevertheless, the methods
of application of patient-controlled analgesia have changed a lot. There are many new
and competing methods of patient-controlled analgesia. To decide for one or another
PCA-method in a given individual postoperative situation is challenging. Each method
has its advantages and disadvantages, which are examined in this doctoral thesis.
To begin with, this work elaborates on requirements to guaranty an “ideal”
postoperative patient-controlled therapy. Afterwards a broad overview of different
established and new PCA-methods is given in order to present the advantages and
disadvantages of the different methods.
As one requirement, the economics of patient-controlled analgesia are further
analyzed, as they will become even more important in the future, due to increasing
costs and cut budgets. Therefore a cost-analysis of the process with iPATS
(iontophoretic patient-activated transdermal system) was conducted as an example of
a new and innovative PCA-method.
Using qualitative expert interviews with expert staff of the department of Anesthesia
and Intensive care of the University Hospital Marburg, a profile of the standards of
patient-controlled analgesia was defined. Employing an informal interview technique,
corresponding requirements to PCA were deduced, evaluated, and clustered.
In a second step, a detailed literature review was conducted regarding the subject:
“Patient-controlled Analgesia”. The literature review aimed to identify all the
established methods of patient-controlled Analgesia, comprising new and not well
established methods. Aspects of the review included a description, mechanisms of
action and presenting evidence of effectiveness and side-effects.
Altogether 13 different requirements of patient-controlled analgesia were identified.
Based on the literature review 3 invasive and 5 non-invasive methods of PCA were
found. These were evaluated regarding the identified requirements and presented in a synopsis. As none of the evaluated PCA-methods met all requirements, it was not
possible to identify an “ideal” method.
Evaluating the economics of patient controlled analgesia was conducted via 22
sequence data entry forms to document the duration of each execution step with the
iPATS. As the execution steps were related to the work processes of medical and
nursing staff, the costs of relevant work processes could be evaluated via the collected
work duration times and the particular personnel expenses. Further on, the overall
process costs consists of work process costs and the material costs for the iPATS.
The duration of a single working process with the iPATS lasted 32 minutes, with
employing medical staff for 30 minutes and nursing staff only 2 minutes. In summary
cost staff labour costed 36 € per day of therapy. With material costs of 135 € per day,
the overall process costs amounted to 171 € per day of treatment with the iPATS.
As a conclusion, a trend towards developing non invasive PCA-methods, e.g. iPATS,
was observed. These can help to minimize side-effects that are due to the actual
application method. Moreover, they are comfortable to apply by the patient and assist
in postoperative mobility and rehabilitation, as no cables or other infrastructure is
required. Nevertheless invasive, well established PCA-methods, like the epidural PCA,
are still indispensable in certain situations due to their superior analgetic efficacy.
Regarding PCA methods it was shown, that innovative PCA methods, e.g. iPATS,
reduced labour time and consequently personnel costs regarding postoperative pain
management; contrary to intravenous PCA. Yet the overall process costs were even
higher with the iPATS, as material costs of the iPATS treatment are comparatively high;
counterbalancing the savings of labour time.
Besides comfortable and reliable pain therapy and other application related factors,
the future challenge for developing new PCA treatments is posed by optimising
treatment processes. Such optimisations aim to reduce treatment costs, conditioned
upon economisation of hospital routines.
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Created: 2011Issued: 2012-02-16Updated: 2012-03-19
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Patient-controlled Analgesia
DFG-subjects
Patientengesteuerte Analgesie
DDC-Numbers
610
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Kahl, Luisa (1018511644): Patientenkontrollierte Analgesie zur Behandlung postoperativer Schmerzen :Herausforderungen und Innovationen. : Philipps-Universität Marburg 2012-02-16. DOI: https://doi.org/10.17192/z2012.0009.
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This item has been published with the following license: In Copyright