J Korean Orthop Assoc.  2022 Feb;57(1):27-34 . 10.4055/jkoa.2022.57.1.27.

Effectiveness and Causes of Early Cessation of Intravenous Patient-Controlled Analgesia in Orthopedic Surgery

• Lee BJ
• Lee CH
• Go J

• KMID: 2525474
• DOI: http://doi.org/10.4055/jkoa.2022.57.1.27

Abstract

Purpose
This study examined the frequency of early cessation of intravenous patient-controlled analgesia (IV-PCA) after orthopedic surgery, and the difference in frequency according to the surgical site and type to determine the factors affecting the early cessation of IVPCA.
Materials and Methods
Based on the medical records of 2,915 patients using PCA after orthopedic surgery from October 2018 to February 2020, sex, age, smoking status, surgical site, operation name, anesthesia method, PCA usage time, satisfaction, side effects, early discontinuation and the reason of early discontinuation were assessed. Orthopedic surgery was classified into major surgery and minor surgery, and the surgical site was classified into the upper limb, lower limb, and spine. The reasons for discontinuation were side effects, patient rejection, and discharge. The factors affecting early discontinuation were identified by univariate analysis, and the degree of each factor affecting early discontinuation was confirmed by logistic regression analysis.
Results
The early discontinuation rate of IV-PCA was 6% (upper limb: 8.3%, lower limb: 5.7%). Univariate analysis identified, age, surgical site, surgical classification, anesthesia method, PCA usage time, satisfaction, and side effects as factors affecting early discontinuation. Logistic regression analysis showed that early discontinuation of the upper limb surgery was higher than the lower extremity surgery (p=0.005, odds ratio [OR]=1.78). Moreover, that the early discontinuation of minority surgery was higher than that of major surgery (p=0.002, OR=2.029). The most common reason for early discontinuation in lower extremity surgery is the side effects (71.5%), whereas patient rejection was the major reason in upper limb surgery (41.7%).
Conclusion
Early cessation of IV-PCA for postoperative pain control was more frequent in upper extremity surgery than lower extremity surgery. The rate of early discontinuation due to simple rejection or discharge of patients was higher in the upper extremity surgery than lower extremity surgery. Therefore, methods such as neuroaxial anesthesia should be considered for pain control after upper limb surgery rather than IV-PCA.

Keyword

upper extremities surgery; postoperative nausea and vomiting; intravenous patient controlled analgesia; pain control