Table 9Summary GRADE table for primary analgesia: patient-controlled analgesia (PCA) morphine compared with intravenous morphine

Number of studiesTreatmentPlaceboMeasure of effectQualityImportance
Pain rating 2 days after treatment (assessed with 11-point verbal response scale, 0–10, with 0 indicating no pain) in adults
Van Beers et al. 2007PCA Morphine (5 mg bolus injection then 0.01 mg/kg by PCA)IV morphine (5 mg bolus injection then 0.03 mg/kg/hour by continuous infusion)Mean verbal response pain score did not differ significantly in the PCA group (5.3, CI 4.5–6.9) compared with the IV group (4.9, CI 3.9–5.8, p = 0.09)ModerateCritical
Pain rating up to 5 days after treatment (assessed with Visual Analogue Scale [VAS]) in adults
Van Beers et al. 2007PCA Morphine (5 mg bolus injection then 0.01 mg/kg by PCA)IV morphine (5 mg bolus injection then 0.03 mg/kg/hour by continuous infusion)Median change from baseline was −3.8 (IQR −5.2 to 4) in the PCA group and −2.4 (−5.7 to −1.1) in the continuous infusion group; not significantly different (p = 1.00)ModerateCritical
Amount of analgesia used in adults
Van Beers et al. 2007PCA Morphine (5 mg bolus injection then 0.01 mg/kg by PCA)IV morphine (5 mg bolus injection then 0.03 mg/kg/hour by continuous infusion)The median morphine dose was significantly lower in the PCA group (0.5 mg/hour, IQR 0.3–0.6) compared with the IV group (2.4 mg/hour, IQR 1.4–4.2, p = 0.001). The median total morphine dose was also significantly lower in the PCA group (33 mg, IQR 10–68) compared with the IV group (260 mg, IQR 204–529)ModerateCritical
Use of additional/rescue doses of analgesia in adults
Van Beers et al. 2007PCA Morphine (5 mg bolus injection then 0.01 mg/kg by PCA)IV morphine (5 mg bolus injection then 0.03 mg/kg/hour by continuous infusion)RR 1.30 (CI 0.53, 3.17) for requiring an increased dose if there is no adequate pain reliefModerateCritical
Adverse events in adults
Van Beers et al. 2007PCA Morphine (5 mg bolus injection then 0.01 mg/kg by PCA)IV morphine (5 mg bolus injection then 0.03 mg/kg/hour by continuous infusion)The area under the curve of experienced nausea (median 11, IQR 3–21, vs 18, IQR 3–55, p = 0.045) and constipation (30, IQR 10–40, vs 45, IQR 36–59, p = 0.02) side-effect scores were significantly lower in the PCA group compared with the IV group.
No significant differences were found for pruritus and sedation.
ModerateCritical
Length of stay in adults
Van Beers et al. 2007PCA Morphine (5 mg bolus injection then 0.01 mg/kg by PCA)IV morphine (5 mg bolus injection then 0.03 mg/kg/hour by continuous infusion)There were no significant differences in the median admission duration in the PCA group (6.0 days, IQR 4.3–9.3) compared with the IV group (9.0 days, IQR 6.0–12.0, p = 0.15)ModerateCritical

Abbreviations: CI, confidence interval; IQR, interquartile range; IV, intravenous; MD, mean difference; PCA, patient-controlled analgesia; RR, relative risk.

From: 2, Evidence review and recommendations

Cover of Sickle Cell Acute Painful Episode
Sickle Cell Acute Painful Episode: Management of an Acute Painful Sickle Cell Episode in Hospital.
NICE Clinical Guidelines, No. 143.
Centre for Clinical Practice at NICE (UK).
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