PAin SoluTions In the Emergency Setting—patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial [急救中心的疼痛解决方案-急诊患者非外伤性腹痛的自控镇痛与常规治疗：随机对照试验]

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BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h3147 (Published 21 June 2015)
Cite this as: BMJ 2015;350:h3147

Authors
Jason E Smith, consultant in emergency medicine, defence professor of emergency medicine, honorary professor, Mark Rockett, consultant in anaesthesia and pain medicine, associate professor, Siobhan Creanor, associate professor (senior lecturer) in health statistics, Rosalyn Squire, research nurse, Chris Hayward, senior trial manager, Paul Ewings, director, Andy Barton, consultant, Colin Pritchard, consultant6, Victoria Eyre, trial manager, Laura Cocking, senior data manager, Jonathan Benger, professor of emergency care on behalf of the PASTIES research team 

Abstract
Objective: To determine whether patient controlled analgesia (PCA) is better than routine care in providing effective analgesia for patients presenting to emergency departments with moderate to severe non-traumatic abdominal pain.

Design: Pragmatic, multicentre, parallel group, randomised controlled trial

Setting: Five English hospitals.

Participants: 200 adults (66% (n=130) female), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe non-traumatic abdominal pain and were expected to be admitted to hospital for at least 12 hours.

Interventions: Patient controlled analgesia or nurse titrated analgesia (treatment as usual).

Main outcome measures: The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant’s hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate or severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management.

Results: 196 participants were included in the primary analyses (99 allocated to PCA and 97 to treatment as usual). Mean total pain experienced was 35.3 (SD 25.8) in the PCA group compared with 47.3 (24.7) in the treatment as usual group. The adjusted between group difference was 6.3 (95% confidence interval 0.7 to 11.9). Participants in the PCA group received significantly more morphine (mean 36.1 (SD 22.4) v 23.6 (13.1) mg; mean difference 12.3 (95% confidence interval 7.2 to 17.4) mg), spent less of the study period in moderate or severe pain (32.6% v 46.9%; mean difference 14.5% (5.6% to 23.5%)), and were more likely to be perfectly or very satisfied with the management of their pain (83% (73/88) v 66% (57/87); adjusted odds ratio 2.56 (1.25 to 5.23)) in comparison with participants in the treatment as usual group.

Conclusions: Significant reductions in pain can be achieved by PCA compared with treatment as usual in patients presenting to the emergency department with non-traumatic abdominal pain.

Trial registration: European Clinical Trials Database EudraCT2011-000194-31; Current Controlled Trials ISRCTN25343280.