[Cost-effectiveness analysis of patient-controlled analgesia compared to continuous elastomeric pump infusion of tramadol and metamizole]

D Hernández García, I Lara Vila, F Caba Barrientos, P Ramos Curado, A Núñez García, M Echevarría Moreno
Revista Española de Anestesiología y Reanimación 2007, 54 (4): 213-20

OBJECTIVES: Little information is available on the cost-effectiveness of postoperative patient-controlled analgesia (PCA). The present study compared PCA to continuous infusion by elastomeric pump.

MATERIAL AND METHODS: Fifty ASA 1 or 2 patients undergoing major gynecologic surgery were enrolled for a randomized controlled trial to evaluate the effectiveness and costs derived from intravenous PCA with metamizole and tramadol compared to continuous infusion of the same analgesic solution by elastomeric pump in the 48 hours following surgery. Patient satisfaction and side effects were also recorded.

RESULTS: The analgesic effectiveness and side effects of the 2 regimens were similar, although 61% of patients in the elastomeric pump group needed morphine for rescue analgesia compared to 33% in the PCA group (P < .05). In the PCA group, 81% of the patients said they would repeat the analgesic treatment compared to only 56% in the elastomeric pump group (P = .05). The mean number of nursing interventions was 16 for the PCA group and 19 for the elastomeric pump group. The mean cost of the treatment (not including the PCA pump, provided by the manufacturer) was Euros 41.35 for the PCA group and Euros 56.22 for the elastomeric pump group.

CONCLUSIONS: The analgesic efficacy of the 2 regimens was similar. However, patient satisfaction was greater with PCA and use of an elastomeric pump was more expensive. In the setting of the present study, postoperative PCA proved to be more advantageous than continuous elastomeric pump infusion.

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