Colella, J., Scrofine, S., Galli, B., Knorr-Mulder, C., Gejerman, G., Scheuch, J., . . . Sawczuk, I. (2006). Prostate HDR radiation therapy: A comparative study evaluating the effectiveness of pain management with peripheral PCA vs. PCEA. Urologic Nursing, 26, 57–61.

To examine the effectiveness of two different types of patient-controlled analgesia (PCA)—peripheral (IV) versus epidural in an effort to develop best practice in pain management for this population

• Phase 1: Control group of 50 patients received peripheral/IV PCA with morphine sulfate
• Phase 2: Experimental group of 50 men received PCEA with bupivacaine and fentanyl

• N = 100
• OTHER KEY SAMPLE CHARACTERISTICS: Patients received four HDR radiation treatments during their hospital stay. Ninety-two patients were implanted with a mean of 20 interstitial HDR catheters. Thirteen percent of patients had diabetes mellitus, 36% had osteoarthritis, and 11% were obese.

• LOCATION: Radiation oncology department in an acute care university medical center in the United States

• Nonrandomized
  • Convenience sample of 100 men receiving HDR brachytherapy

• Pain assessment, number of HDR catheters, comorbid conditions
• Pain assessed at five points—baseline, pre-CT 2 hours after HDR implant, 5 hours after implant, 13 hours after implant, 24 hours after implant, and 30 hours after implant
• Brief Pain Inventory Scale (BPIS) was used (0–10). Sites of pain evaluated were foley catheter, interstitial catheters (perineum), and back (lumbosacral).
• Pain score was given to the nurse verbally, who then recorded it.

The phase 1 control group with PCA had the following mean ratings for pain: back, 2.7; foley catheter, 3.4; perineal interstitial catheter, 3.0.

The phase 2 experimental group with PCEA had the following mean ratings for pain: back, 0.5; foley catheter, 0.6; perineal interstitial catheter, 0.7.

PCA was associated with increased pain intensity. Foley pain was worse with arthritis and obesity.  Back pain increased, interstitial pain decreased, and pain increased with the number of catheters. The PCEA group experienced significantly less pain at five-points-of-pain assessment from the control group.

Patients with PCA had greater pain and less pain relief.

• PCA had demand dosing but no basal dose. PCEA had demand and basal doses. Maybe the pain improved because of having basal and demand dosing.  
• The drug was different for each group, so it is difficult to ascertain if the changed route or the changed drug improved pain relief.  
• Nonrandomized, convenience sample
• Not noted if patients’ comorbidities were stratified.
• Participants’ age, stage of disease, history of opioid use, use of non-opioid or coanalgesics, and dose of brachytherapy were not noted.
• Each group was treated sequentially—the first group from July 2003–November 2003 and the second group from December 2003–February 2004. Were there any practice changes?