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http://dx.doi.org/10.7586/jkbns.2018.20.4.236

Factors Associated with Discontinuation of Postoperative Intravenous Patient Controlled Analgesia  

Lee, Kyungran (Gachon University Gil Hispital)
Kim, Yunmi (College of Nursing, Gachon University)
Publication Information
Journal of Korean Biological Nursing Science / v.20, no.4, 2018 , pp. 236-243 More about this Journal
Abstract
Purpose: The purpose of this study was to identify the factors associated with the discontinuation of patient controlled analgesia (PCA) after surgery. Methods: The data of 1,092 adult patients that were over 20 years of age and underwent PCA after surgery in the Gachon University Hospital from May 1 to June 30, 2017, were collected through the patients' Electronic Medical Record (EMR). The collected data was analyzed via the use of the Chi-test, t-test and multivariate logistic regression analysis using SPSS 18.0 program. Results: The postoperative PCA discontinuation rate was 26.1%. It was associated with various symptoms, such as those of nausea, dizziness, and headache. The PCA discontinuation was also related with female (odds ratio, OR= 1.75; confidence interval, CI= 1.09-2.82), nausea (OR= 105.27; CI= 61.03-181.58), total intravenous anesthesia (TIVA) of the thyroidectomy (OR= 10.43; CI= 5.01-21.70). Conclusion: It is necessary to provide additional medication and nursing interventions to reduce nausea, which is the symptom associated with PCA discontinuation, especially in the operation of female subjects and thyroidectomy under TIVA. That is, those who are at a high risk for PCA discontinuation should be able to administer additional antiemetics or reduce non medication nursing interventions.
Keywords
Patient-controlled analgesia; Postoperative nausea and vomiting;
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1 Lee YS, Son JS, Yoon HS. Risk factors and level of acute post-operative pain in surgical patients during the first 48 hours after surgery. Journal of Korean Biological Nursing Science. 2014;16(3):226-234. http://dx.doi.org/10.7586/jkbns.2014.16.3.226   DOI
2 Ryu SH, Jo HS. Effect of real patient controlled analgesia (PCA) education with practice on postoperative pain, consumption of analgesics, and anxiety for elderly patients with total hip arthroplasty. Journal of Korean Clinical Nursing Research. 2016;22(2):152-160. https://doi.org/10.22650/JKCNR.2016.22.2.152   DOI
3 Sung MH, Kim MY, Em OB. The effects of pain management education using patient-controlled analgesia pump in post-surgical patients. Korean Journal of Health Promotion. 2010;10:169-176.
4 Chumbley G, Mountford L. Patient-controlled analgesia infusion pumps for adults. Nursing Standard. 2010;25(8):35-40. https://doi.org/10.7748/ns2010.10.25.8.35.c8067   DOI
5 Kol E, Alpar SE, Erdogan A. Preoperative education and use of analgesic before onset of pain routinely for post-thoracotomy pain control can reduce pain effect and total amount of analgesics administered postoperatively. Pain Management Nursing. 2014;15(1):331-339. https://doi.org/10.1016/j.pmn.2012.11.001   DOI
6 Ferguson R, Williams ML, Beard B. Combining quality improvement and staff development efforts to decrease patient-controlled analgesia pump errors. Journal for Nurses in Staff Development. 2010;26(5):E1-E4. https://doi.org/10.1097/NND.0b013e3181b1b9d2
7 Korean Society of Anetheologists. Anesthesia and pain medicine. 1st ed. Seoul: Yeomoongak; 2014. p. 317-319.
8 Aubrun F, Langeron O, Quesnel C, Coriat P, Riou B. Relationships between measurement of pain using visual score and morphine requirements during postoperative intravenous morphine titration. Anesthesiolosy. 2003;98(6):1415-1421.   DOI
9 Lee JH, Jo HS. Effects of a structured patient controlled analgesia (PCA) education on knowledge and attitude regarding PCA usage, pain, and consumption of analgesics in colorectal surgery patients. Journal of Korean Clinical Nursing Research. 2011;17(3):455-466.
10 Nam MO, Yoon HS. Effect of ondansetron combined with dexamethasone on postoperative nausea & vomiting and pain of patients with laparoscopic hysterectomy. Journal of Korean Academy of Nursing. 2009;39(1):44-52. https://doi.org/10.4040/jkan.2009.39.1.44   DOI
11 Oh IO, Yoo JY, Oh EG. Development and evaluation of an evidence-based nurs ing protocol for postoperative nausea and vomiting. Journal of Korean Biological Nursing Science. 2017;19(2):86-97. https://doi.org/10.7586/jkbns.2017.19.2.86   DOI
12 Son JS, Yoon HS. Factors affecting postoperative nausea and vomiting in surgical patients. Journal of Perianesthesia Nursing. Published online: 2017;33(4):461-470. https://doi.org/10.1016/j.jopan.2016.02.012   DOI
13 Kim KO, Roh JW, Shin EJ, In J. Factors affecting unused remaining volume of intravenous patient-controlled analgesia in patients following laparoscopic gynecologic surgery. Asian Nursing Research. 2014;8(4):300-304. http://dx.doi.org/10.1016/j.anr.2014.10.003   DOI
14 Kang YJ, Eun SJ, Park EW, Lee SY, Kang JM. Quality improvement for reducing intravenous patient-controlled analgesia self-discontinuation rate. Korean Journal of Anesthesiology, 2014;67:118-119. http://dx.doi.org/10.4097/kjae.2014.67.S.S118   DOI
15 Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.   DOI
16 Cho EA, Jang JS, Kim KH. Influence factors for predicting postoperative nausea and vomiting. Journal of the Korea Contents Association. 2017;17(6):632-642. https://doi.org/10.5392/JKCA.2017.17.06.632   DOI
17 Choi JE. The study on the development and the effect of PCA education program including preparatory sensory information for gynecologic surgery patients [master's thesis]. Seoul: Korea University; 2009. p. 74.
18 Apariman S, Ratchnon S. Effectiveness of giner for prevention of nausea and vomiting after gynecologocal laparoscopy. Journal of the Medical Association of Thailand. 2006;89:2003-2009.
19 Rhodes, V. Criteria for assessment of nausea, vomiting, retching. Oncology Nursing Forum. 1997; 24:13-19.
20 Jang HJ, Park SY. Combination effects of capsicum plaster at the Korean hand acupuncture points K-D2 with prophylactic antiemetic on postoperative nausea and vomiting after gynecologic laparoscopy. Journal of Korean Academy Nursing. 2014;43(2):215-224. http://dx.doi.org/10.4040/jkan.2013.43.2.215   DOI
21 Afel CC. Postoperative nausea and vomiting (PONV): Usefulness of the Afelscore for identification of high risk patienrs for PONV. Academy of Anaesthia Belgium. 2006;57:361-363.
22 Kim MW. Postoperative nausea and vomiting. Dongguk Journal of Medicine. 2004;11(1):151-156.
23 Paek SH, Lee KE, Bae DS, Koo DH, Choi JY, Youn YK. Analysis of postoperative nausea and vomiting-related factors in thyroid and parathyroid surgery. Korean Journal of Clinical Oncology. 2011;7(2):22-27.   DOI
24 Kwon JH. Effects of Nei-guan (P6) acupressure wristband on the nausea, vomiting, and retching for female thyroidectomy patients. [master's thesis]. Daegu: Keimyung University; 2010. p. 29.
25 Park BJ, Shin JS, Im HB. A comparative study of alkaloids contents in tobacco shred and major components contents in tobacco smoke from cigarette brands being on sale in Korea. The Korean Journal of Tabacco Science. 2006;20:1-11.
26 Lee IO. The postoperative adverse effects of inhalational anesthetics: Emergence delirium and PONV. Korean Journal of Anesthesiology. 2007;52(1):1-8.   DOI
27 Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992;77:162-184.   DOI
28 Yoo YC, Bai SJ, Lee KY, Shin S, Choi EK, Lee JW. Total intraveneous anesthesia with propofol reduces postoperative nauea and vomiting in patiens undergoing robot-assisted laparoscopic radical prostatectomy. Yonsei Medical Journal. 2012;53(6):1197-1202.   DOI
29 Lee SH, Hong SJ, Kim HS, Jeon YH. Effect of evidence-based clinical practice guidelines for promotion of postoperative nausea and vomiting of patients with laparoscopic hysterectomy. Korean Journal of Adult Nursing. 2015;27(5):481-492. https://doi.org/10.7475/kjan.2015.27.5.481   DOI