School of Medicine and Health Sciences Poster Presentations

Title

Authorized Agent Controlled Analgesia Improves Pain Control in Critically Ill Adult Patients

Poster Number

200

Document Type

Poster

Publication Date

3-2016

Abstract

Learning objectives: The efficacy and safety of authorized agent controlled analgesia (AACA), also known as patient controlled analgesia by proxy, is documented in the pediatric literature. Most adult intensive care units do not offer this therapy. This study evaluates the efficacy and safety of AACA in the critically ill adult patient.

Methods: A retrospective observational study was performed after an AACA protocol was introduced in a 42 bed mixed medical/surgical ICU. Patients requiring mechanical ventilation, frequent opioid dosing, or comfort care were independently placed on AACA by the ICU team. Nonverbal pain score and Richmond Agitation Sedation Severity Score (RASS) along with opioid and sedative use were abstracted 24 hours before and after intervention. Scores were compared using paired student t-tests. A mixed regression model adjusting for hour was used to control for change in pain over time. A random-effects mixed model was used to test whether the slope of pain scores differed from pre to post-AACA. A fixed effects mixed model was used to control for use of non-narcotic medications.

Results: Among the 46 patients studied, the mean number of pain score evaluations was 9.3±5.0 pre- and 10.4±4.5 post-AACA. Mean change in pain score was -3.4±2.0 (95% confidence interval -4.0 to -2.7). This represented a significant 70% drop in mean pain score (p<0.0001), from a pre-AACA mean of 4.8±1.8 to a post-AACA mean of 1.5±1.6. Examination of the slope of pain scores by hour found little change within the pre- and post-AACA period, with a large drop from pre- to post-AACA. Mean RASS score decreased significantly (-0.2±1.9 v -1.6±1.3, p<0.0001), but in the model controlling for use of sedatives and analgesic medications, the effect of AACA on pain scores (pre- vs post-) remained significant (p<0.0001). No patient required naloxone.

Conclusions: Use of AACA is associated with a significant reduction in pain scores in critically ill patients. Larger studies are warranted to confirm these findings.

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Presented at: GW Research Days 2016

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Authorized Agent Controlled Analgesia Improves Pain Control in Critically Ill Adult Patients

Learning objectives: The efficacy and safety of authorized agent controlled analgesia (AACA), also known as patient controlled analgesia by proxy, is documented in the pediatric literature. Most adult intensive care units do not offer this therapy. This study evaluates the efficacy and safety of AACA in the critically ill adult patient.

Methods: A retrospective observational study was performed after an AACA protocol was introduced in a 42 bed mixed medical/surgical ICU. Patients requiring mechanical ventilation, frequent opioid dosing, or comfort care were independently placed on AACA by the ICU team. Nonverbal pain score and Richmond Agitation Sedation Severity Score (RASS) along with opioid and sedative use were abstracted 24 hours before and after intervention. Scores were compared using paired student t-tests. A mixed regression model adjusting for hour was used to control for change in pain over time. A random-effects mixed model was used to test whether the slope of pain scores differed from pre to post-AACA. A fixed effects mixed model was used to control for use of non-narcotic medications.

Results: Among the 46 patients studied, the mean number of pain score evaluations was 9.3±5.0 pre- and 10.4±4.5 post-AACA. Mean change in pain score was -3.4±2.0 (95% confidence interval -4.0 to -2.7). This represented a significant 70% drop in mean pain score (p<0.0001), from a pre-AACA mean of 4.8±1.8 to a post-AACA mean of 1.5±1.6. Examination of the slope of pain scores by hour found little change within the pre- and post-AACA period, with a large drop from pre- to post-AACA. Mean RASS score decreased significantly (-0.2±1.9 v -1.6±1.3, p<0.0001), but in the model controlling for use of sedatives and analgesic medications, the effect of AACA on pain scores (pre- vs post-) remained significant (p<0.0001). No patient required naloxone.

Conclusions: Use of AACA is associated with a significant reduction in pain scores in critically ill patients. Larger studies are warranted to confirm these findings.