Abstract | BACKGROUND AND OBJECTIVE: Post-operative analgesic consumption is often used as a surrogate measure for pain; analyses of mean data assume a Gaussian distribution and use parametric statistics to assess statistical differences, often in small samples. We used a large individual patient dataset to examine the distribution of analgesic consumption, the validity of such analyses and alternative dichotomous outcomes. METHODS: RESULTS: The distribution of analgesic consumption for all patients over the periods 0-24, 24-48 and 0-48 h was exponential. Most patients used less than 750 μg fentanyl over 48 h; 34% used over 1000 μg fentanyl (100 mg morphine), 13% over 2000 μg and 5% over 3000 μg. Mean, median and mode were very different; 20% of patients consumed almost 60% of post-operative analgesic, and standard deviations were generally larger than means. A useful dichotomous outcome was less than 750 μg fentanyl consumed over 48 h, a level associated with very good or excellent patient pain rating. Use of very good or excellent patient pain rating differentiated between different doses of epidural morphine. CONCLUSION: Because of a highly skewed distribution, post-operative analgesic consumption is an uncertain method of measuring analgesic efficacy of an intervention designed to limit pain during and after surgery.
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Authors | Robert A Moore, Róisín J Ní Mhuircheartaigh, Sheena Derry, Henry J McQuay |
Journal | European journal of anaesthesiology
(Eur J Anaesthesiol)
Vol. 28
Issue 6
Pg. 427-32
(Jun 2011)
ISSN: 1365-2346 [Electronic] England |
PMID | 21445017
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
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Chemical References |
- Analgesics
- Analgesics, Opioid
- Placebos
- Morphine
- Fentanyl
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Topics |
- Abdomen
(surgery)
- Analgesia, Patient-Controlled
- Analgesics
(therapeutic use)
- Analgesics, Opioid
(therapeutic use)
- Arthroplasty, Replacement, Hip
(methods)
- Cesarean Section
(methods)
- Female
- Fentanyl
(therapeutic use)
- Humans
- Injections, Epidural
- Male
- Models, Statistical
- Morphine
(therapeutic use)
- Normal Distribution
- Pain, Postoperative
(drug therapy)
- Placebos
- Randomized Controlled Trials as Topic
- Time Factors
- Treatment Outcome
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