Page 14 Acute Pain Management

7. PCA, REGIONAL AND OTHER LOCAL ANALGESIA TECHNIQUES................................... 171
7.1 Patient‐controlled analgesia..................................................................................... 171
7.1.1 Efficacy of intravenous PCA...............................................................................171
7.1.2 Drugs used for parenteral PCA..........................................................................172
7.1.3 Program parameters for intravenous PCA ........................................................175
7.1.4 Efficacy of PCA using other systemic routes of administration.........................176
CONTENTS 7.1.6 Equipment.........................................................................................................178
7.1.5
Complications related to PCA............................................................................177
Patient and staff factors....................................................................................179
7.1.7
PCA in specific patient groups...........................................................................180
7.1.8
7.2 Epidural analgesia .................................................................................................... 182
7.2.1 Efficacy ..............................................................................................................182
7.2.2 Drug used for epidural analgesia.......................................................................184
7.2.3 Patient‐controlled epidural analgesia ...............................................................185
7.2.4 Adverse effects..................................................................................................186
7.3 Intrathecal analgesia................................................................................................ 190
7.3.1 Drugs used for intrathecal analgesia.................................................................190
7.3.2 Combined spinal‐epidural versus epidural analgesia in labour.........................192
7.4 Regional analgesia and concurrent anticoagulant medications................................. 193
7.4.1 Neuraxial blockade............................................................................................193
7.4.2 Plexus and other peripheral regional blockade.................................................195
7.5 Other regional and local analgesic techniques.......................................................... 195
7.5.1 Continuous peripheral nerve blockade .............................................................195
7.5.2 Intra‐articular analgesia ....................................................................................199
7.5.3 Wound infiltration including wound catheters .................................................200
7.5.4 Topical application of local anaesthetics...........................................................200
7.5.5 Safety.................................................................................................................201
References ....................................................................................................................... 204
8. NON‐PHARMACOLOGICAL TECHNIQUES ................................................................... 221
8.1 Psychological interventions...................................................................................... 221
8.1.1 Provision of information....................................................................................221
8.1.2 Stress and tension reduction.............................................................................222
8.1.3 Attentional techniques......................................................................................223
8.1.4 Cognitive‐behavioural interventions.................................................................224
8.2 Transcutaneous electrical nerve stimulation ............................................................ 226
8.3 Acupuncture ............................................................................................................ 227
8.4 Other physical therapies .......................................................................................... 228
8.4.1 Manual and massage therapies.........................................................................228
8.4.2 Heat and cold ....................................................................................................228
8.4.3 Other therapies .................................................................................................228
References ....................................................................................................................... 229

xiv Acute Pain Management: Scientific Evidence