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

Performance improvement project examining the effectiveness of two different types of patient- controlled analgesia – peripheral (intravenous) versus. epidural in an effort to develop best practice in pain management for this population.

92 patients were implanted with a mean of 20 interstitial HDR catheters Phase 1 – control group of 50 patients received peripheral/intravenous PCA with morphine sulfate. Phase 2 – experimental group of 50 men received PCEA with bupivacaine and fentanyl.

Patients received 4 HDR radiation treatments during their hospital stay. Nonrandomized, convenience sample of 100 men receiving HDR brachytherapy. 92 patients were implanted with a mean of 20 interstitial HDR catheters. 13% of patients had diabetes mellitus, 36% osteoarthritis, and11% were obese.

Radiation oncology department in an acute care university medical center USA

Pain assessment, number of HDR catheters, comorbid conditions Pain assessed at 5 point – baseline, pre CT 2 hours after HDR implant, five 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.

Phase 1 control group with PCA had mean ratings for pain: back 2.7, foley catheter 3.4, perineal interstitial catheter 3.0. Phase 2 experimental group with PCEA: back 0.5, foley 0.6, perineal interstitial catheter 0.7. PCA was associated with increased pain intensity. Foley pain worse with arthritis and obesity. Back pain increased, interstitial pain decreased, and pain increased with the number of catheters. PCEA experienced significantly less pain at their five-points-of-pain assessment from the control group.

PCA patients 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. Not noted participants’ age, stage of disease, history of opioid use, use of non-opioid or coanalgesics, dose of brachytherapy Each group was treated sequentially, the first group July 2003-November 2003, second group December 2003 to February 2004. Were there any practice changes?