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PAIN SOLUTION IN THE EMERGENCY SETTING (PASTIES); AN OPEN-LABEL RANDOMISED TRIAL OF PATIENT-CONTROLLED ANALGESIA (PCA) VERSUS ROUTINE CARE IN PATIENTS ATTENDING THE EMERGENCY DEPARTMENT WITH TRAUMATIC INJURIES
  1. Jason E Smith1,2,
  2. Mark Rockett3,
  3. Rosalyn Squire1,
  4. Chris Hayward4,
  5. Siobhan Creanor5,
  6. Paul Ewings6,
  7. Andy Barton6,
  8. Colin Pritchard6,
  9. Jonathan Benger7
  1. 1Emergency Department, Derriford Hospital, Plymouth, United Kingdom
  2. 2Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom
  3. 3Derriford Hospital, Plymouth, United Kingdom
  4. 4Peninsula Clinical Trials Unit, Plymouth, United Kingdom
  5. 5Centre for Health and Environmental Statistics, University of Plymouth, Plymouth, United Kingdom
  6. 6SW Research Design Service, Plymouth, United Kingdom
  7. 7University of the West of England, Bristol, United Kingdom

    Abstract

    Objectives & Background Pain is the commonest reason that patients present to an Emergency Department (ED), but is often not treated effectively. Patient controlled analgesia (PCA) is used in other hospital settings but there is little evidence to support its use in emergency patients. This study (one of two parallel trials) aimed to assess the effectiveness and cost-effectiveness of PCA in emergency patients with traumatic injuries.

    Methods Prospective multi-centre randomised trial of PCA versus routine care (nurse-titrated analgesia) in emergency department patients presenting with traumatic injuries, who required IV opioid analgesia and admission to hospital. Participants were randomised to receive either routine care or PCA, and followed for the first 12 hours of their hospital stay. The primary outcome measure was hourly participant-recorded pain, scored using a visual analogue scale (VAS), with primary statistical analyses based on the standardised (scaled from 0–100) area-under–the-curve (AUC) of each participant's pain scores, with adjustment for time of admission, centre and baseline pain score.

    Results 200 participants (71% male) were recruited from 4 centres, mean (SD) age of 43 (15.0) years. Preliminary analysis showed mean (SD) standardised pain AUCs were 47.2 (21.9) for the routine care group and 44.0 (24.0) for the PCA group. Provisional adjusted analyses indicated a slightly lower (but not statistically significant) standardised pain AUC in the PCA group than for the routine care group (mean difference (routine care -PCA): 2.7; 95% confidence interval; –2.4 to 7.8).

    Conclusion Provisional results indicate that there is no statistically significant reduction in pain using PCA compared to routine care for emergency department patients with traumatic injuries. Further analyses are in progress, in particular, of total morphine consumption and cost-effectiveness.

    • emergency care systems

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