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PAin SoluTions In the Emergency Setting (PASTIES)--patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial.

机译：紧急情况下的疼痛解决方案（PASTIES）-非创伤性腹痛的急诊患者的患者自控镇痛与常规护理：随机试验。

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OBJECTIVE: To determine whether patient controlled analgesia (PCA) is better than routine care in providing effective analgesia for patients presenting to emergency departments with moderate to severe non-traumatic abdominal pain. DESIGN: Pragmatic, multicentre, parallel group, randomised controlled trial SETTING: Five English hospitals. PARTICIPANTS: 200 adults (66% (n=130) female), aged 18 to 75 years, who presented to the emergency department requiring intravenous opioid analgesia for the treatment of moderate to severe non-traumatic abdominal pain and were expected to be admitted to hospital for at least 12 hours. INTERVENTIONS: Patient controlled analgesia or nurse titrated analgesia (treatment as usual). MAIN OUTCOME MEASURES: The primary outcome was total pain experienced over the 12 hour study period, derived by standardised area under the curve (scaled from 0 to 100) of each participant's hourly pain scores, captured using a visual analogue scale. Pre-specified secondary outcomes included total morphine use, percentage of study period in moderate or severe pain, percentage of study period asleep, length of hospital stay, and satisfaction with pain management. RESULTS: 196 participants were included in the primary analyses (99 allocated to PCA and 97 to treatment as usual). Mean total pain experienced was 35.3 (SD 25.8) in the PCA group compared with 47.3 (24.7) in the treatment as usual group. The adjusted between group difference was 6.3 (95% confidence interval 0.7 to 11.9). Participants in the PCA group received significantly more morphine (mean 36.1 (SD 22.4) v 23.6 (13.1) mg; mean difference 12.3 (95% confidence interval 7.2 to 17.4) mg), spent less of the study period in moderate or severe pain (32.6% v 46.9%; mean difference 14.5% (5.6% to 23.5%)), and were more likely to be perfectly or very satisfied with the management of their pain (83% (73/88) v 66% (57/87); adjusted odds ratio 2.56 (1.25 to 5.23)) in comparison with participants in the treatment as usual group. CONCLUSIONS: Significant reductions in pain can be achieved by PCA compared with treatment as usual in patients presenting to the emergency department with non-traumatic abdominal pain. Trial registration European Clinical Trials Database EudraCT2011-000194-31; Current Controlled Trials ISRCTN25343280.
机译：目的：确定患者自控镇痛（PCA）是否比常规护理更好，以便为急诊科中度至重度非创伤性腹痛患者提供有效的镇痛效果。设计：务实，多中心，平行小组，随机对照试验地点：五家英国医院。参与者：200名成年人（66％（n = 130）女性），年龄18至75岁，他们曾到急诊科就诊，需要静脉使用阿片类药物镇痛以治疗中度至重度非创伤性腹痛，并有望入院。住院至少12小时。干预措施：患者自控镇痛或护士滴定镇痛（照常治疗）。主要观察指标：主要观察结果是在12个小时的研究期内经历的总疼痛，由每个参与者的每小时疼痛评分曲线下的标准化面积（从0到100缩放）得出，并使用视觉模拟量表记录。预先指定的次要结局包括总吗啡使用量，中度或重度疼痛研究阶段的百分比，睡眠期间研究阶段的百分比，住院时间和对疼痛管理的满意度。结果：196名参与者包括在主要分析中（99名分配给PCA，97名分配给常规治疗）。 PCA组经历的平均总疼痛为35.3（SD 25.8），而正常组为47.3（24.7）。组间差异的调整为6.3（95％置信区间0.7到11.9）。 PCA组的参与者接受了更多的吗啡（平均36.1（SD 22.4）v 23.6（13.1）mg;平均差异12.3（95％置信区间7.2至17.4）mg），在中度或重度疼痛中花费了较少的研究时间（ 32.6％v 46.9％；平均差异14.5％（5.6％至23.5％）），并且更可能对疼痛的治疗感到完全或非常满意（83％（73/88）v 66％（57/87） ）；与通常治疗组的参与者相比，调整后的优势比为2.56（1.25至5.23））。结论：与常规治疗相比，在非创伤性腹痛的急诊患者中，PCA与常规治疗相比可显着减轻疼痛。试验注册欧洲临床试验数据库EudraCT2011-000194-31；电流对照试验ISRCTN25343280。

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