Submited on: 12 Mar 2013 04:36:19 AM GMT
Published on: 12 Mar 2013 06:48:12 AM GMT
 
Visual Analogue Scale Specific Patient-Controlled Analgesia
Posted by Dr. William J Maloney on 11 Feb 2014 04:28:15 PM GMT Reviewed by Interested Peers

  • What are the main claims of the paper and how important are they?

    The author's goal is to present a system which would ensure adequate perioperative analgesia.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes- It would make for a great seminar in a hospital.


  • Other Comments:

    The author states that one of the pain mangagement modalities that is frequently used in perioperative settings is patient-controlled analgesia for parenteral opioids. The author goes on to suggest that the innovation described within his article should be present in pre-existing PCA models. This would allow for clinical trials to be initiated.  A useful list of references is also provided.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    Clinical associate professor

  • How to cite:  Maloney W J.Visual Analogue Scale Specific Patient-Controlled Analgesia[Review of the article 'Visual Analogue Scale Specific Patient-Controlled Analgesia (VAS Guided PCA) ' by Gupta D].WebmedCentral 2013;5(2):WMCRW002972
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  • What are the main claims of the paper and how important are they?

    Patient-controlled analgesia (PCA) is a system of providing analgesics through which the patient is able to self-administer the analgesic whenever required.The purpose of PCA is improved pain control allowing for immediate delivery of analgesics without any undesirable delay.However, an understanding of how to work with PCA and abundant physical strength for pressing a button is inevitable. This could restrict PCA to the patients who do not have the following criteria:unconsciousness, patients with neurologic disease or head injuries in whom narcotics would mask neurologic changes.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    To the best of my knowledge, the idea is origional.


  • Are the claims properly placed in the context of the previous literature?

    NA


  • Do the results support the claims? If not, what other evidence is required?

    NA


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Further clinical trials are required to clarify the practicality of the hypothesis.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes. Yes. It would provide a step forward a better pain management which is every clinician's ultimate objective.


  • Other Comments:

    NA

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Anesthesiologist. Pain management.

  • How to cite:  Golzari S E.Visual Analogue Scale Specific Patient-Controlled Analgesia (VAS Guided PCA)[Review of the article 'Visual Analogue Scale Specific Patient-Controlled Analgesia (VAS Guided PCA) ' by Gupta D].WebmedCentral 2013;4(3):WMCRW002627
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  • What are the main claims of the paper and how important are they?

    Patient-controlled analgesia (PCA) is any method of allowing a person in pain to administer their own pain relief. The infusion is programmable by the prescriber. Currently, it is operated by the patient through a single button device. When the subject is in pain, he/she will press the button and the device will administer the prescribed dose of analgesic drug. This mechanism does not permit to discriminate how much pain the patient is feeling. It could be a VAS 10 or a VAS 5, either way the patient will get the same dose of drug. Hence the pain treatment is not optimized, as over- or underdosing may occur. The author suggests the use of a patient controlled analgesia device based on the actual VAS report by patients, rather than on the simple subjective feeling of pain. The patient will assess his/her VAS and press the specific number on the remote. This will prompt the PCA pump to deliver the appropriate drug dose as prescribed by caregivers. 


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes, I am not aware of any published study on the topic.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    N/A. This is an expert opinion suggesting a possible future implementation of the technique. The issue certainly deserves further RCT to be fully evaluated with regard to efficacy and safety. Some intrinsic disadvantages of PCA would probably be increased by this technique: the possibility of abuse; inappropriateness for individuals with learning difficulties or confusion, patients with poor manual dexterity, those who are critically ill. younger patients.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    N/A. This is an expert opinion.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    N/A. This is an expert opinion.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    N/A. This is an expert opinion.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes, the paper would deserve great attention, as the technique suggested could represent a major advantage in terms of analgesia safety and efficacy. Patients in pain would benefit from a more targeted approach to pain control. The pain I feel determines the analgesic dose I get. This would hopefully translate into better pain control with less drug consumption and fewer side effects.


  • Other Comments:

    None

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:

    No

  • Experience and credentials in the specific area of science:

    MSc in Pain Management. Head, Pain Service.

  • How to cite:  Luchetti M .VAS Guided Patient Controlled Analgesia: A Step Forward to Improving Pain Relief?[Review of the article 'Visual Analogue Scale Specific Patient-Controlled Analgesia (VAS Guided PCA) ' by Gupta D].WebmedCentral 2013;4(3):WMCRW002598
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