Title: A randomised trial of patient controlled analgesia (PCA) versus routine care in the Emergency Department
Funder: Department of Health (England)

Abstract: Background Pain is an extremely common presentation to Emergency Departments (EDs), but is often difficult to treat effectively. Almost half of patients recently surveyed thought more could be done to treat their pain in the ED. Routine treatment of severe pain involves intermittent doses of intravenous morphine, administered by nurses. Patient controlled analgesia (PCA) is effective in many clinical settings, but there is very little evidence relating to its use in the ED. One previous small study failed to show a significant difference between PCA and routine care, but had follow up limited to four hours. No previous study has investigated the issue of continuing a PCA from the emergency department and during the first few hours of a patient’s admission to hospital, to optimise their pain relief. Aims The motivation for this study comes from a desire to improve pain relief for patients in all Emergency Departments. PCAs are already used in most hospitals in the UK in various settings. This health care intervention is easy to use, widely available, and cost-effective for many groups of patients. It is easily transferable across all hospitals that treat patients in pain. The aim of this study is to compare PCA with routine care (nurse titrated analgesia) in adult emergency patients who present in pain from traumatic injuries or non-traumatic abdominal pain, and are then admitted to an inpatient ward. It is our hypothesis that by using patient controlled analgesia, emergency patients can experience improved and more cost-effective pain relief. Plan of Investigation A non-blinded randomised trial of PCA versus routine care in adult patients presenting to our ED in pain from traumatic injury or non-traumatic abdominal pain, who are then admitted to a hospital ward. The primary outcome is a self-administered visual analogue scale pain score completed at 30-minute intervals for four hours and then one-hourly for eight hours. Secondary outcomes include total opioid dose and other analgesic use, physiological parameters as routinely recorded on patient observation chart, adverse effects recorded by patient and nurse, patient satisfaction, number of nurse interventions for analgesia or complication of analgesia management, and % of time with VAS pain score >44mm. An economic evaluation will compare PCA with standard care in a cost-effectiveness analysis. Potential Impact Pain is a huge problem in every emergency department in the UK. We are suggesting a novel use of already existing technology. If this study has a positive result, it may revolutionise the way emergency patients are treated. If we find that use of patient-controlled analgesia improves pain relief and is cost-effective, then large numbers of patients should benefit. PCAs are already used by most UK hospitals dealing with patients in non-ED settings and therefore the technology could easily be transferred to EDs. If we find that PCA is not effective in this situation we can provide evidence to ensure an ineffective intervention is not widely adopted. No previous study has looked at using PCA for emergency patients and during the first few hours of their admission to hospital.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE