{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:24:00Z","timestamp":1785252240422,"version":"3.55.0"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T00:00:00Z","timestamp":1580169600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004564","name":"MINISTRY OF EDUCATION, SCIENCE AND TECHNOLOGICAL DEVELOPMENT OF THE REPUBLIC OF SERBIA","doi-asserted-by":"publisher","award":["175014"],"award-info":[{"award-number":["175014"]}],"id":[{"id":"10.13039\/501100004564","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MINISTRY OF DEFENSE OF THE REPUBLIC OF SERBIA","award":["MFVMA\/05\/19-21"],"award-info":[{"award-number":["MFVMA\/05\/19-21"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This prospective randomized study aims to evaluate the feasibility and cost-effectiveness of combining transcranial direct current stimulation (tDCS) with patient controlled intravenous morphine analgesia (PCA-IV) as part of multimodal analgesia after thoracotomy. Patients assigned to the active treatment group (a-tDCS, n = 27) received tDCS over the left primary motor cortex for five days, whereas patients assigned to the control group (sham-tDCS, n = 28) received sham tDCS stimulations. All patients received postoperative PCA-IV morphine. For cost-effectiveness analysis we used data about total amount of PCA-IV morphine and maximum visual analog pain scale with cough (VASP-Cmax). Direct costs of hospitalization were assumed as equal for both groups. Cost-effectiveness analysis was performed with the incremental cost-effectiveness ratio (ICER), expressed as the incremental cost (RSD or US$) per incremental gain in mm of VASP-Cmax reduction. Calculated ICER was 510.87 RSD per VASP-Cmax 1 mm reduction. Conversion on USA market (USA data 1.325 US$ for 1 mg of morphine) revealed ICER of 189.08 US$ or 18960.39 RSD\/1 VASP-Cmax 1 mm reduction. Cost-effectiveness expressed through ICER showed significant reduction of PCA-IV morphine costs in the tDCS group. Further investigation of tDCS benefits with regards to reduction of postoperative pain treatment costs should also include the long-term benefits of reduced morphine use.<\/jats:p>","DOI":"10.3390\/ijerph17030816","type":"journal-article","created":{"date-parts":[[2020,1,28]],"date-time":"2020-01-28T09:37:09Z","timestamp":1580204229000},"page":"816","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Patient-Controlled Intravenous Morphine Analgesia Combined with Transcranial Direct Current Stimulation for Post-Thoracotomy Pain: A Cost-Effectiveness Study and A Feasibility for Its Future Implementation"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5122-8094","authenticated-orcid":false,"given":"Nemanja","family":"Rancic","sequence":"first","affiliation":[{"name":"Medical Faculty Military Medical Academy, University of Defense, 11 000 Belgrade, Serbia"},{"name":"Center for Clinical Pharmacology, Military Medical Academy, 11 000 Belgrade, Serbia"},{"name":"Institute of Radiology, Military Medical Academy, 11 000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Mladenovic","sequence":"additional","affiliation":[{"name":"Medical Faculty Military Medical Academy, University of Defense, 11 000 Belgrade, Serbia"},{"name":"Department of Anesthesiology and Intensive Care, Military Medical Academy, 11 000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nela V.","family":"Ilic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11 000 Belgrade, Serbia"},{"name":"Clinic of Physical Medicine and Rehabilitation, Clinical Center of Serbia, 11 000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1979-0762","authenticated-orcid":false,"given":"Viktorija","family":"Dragojevic-Simic","sequence":"additional","affiliation":[{"name":"Medical Faculty Military Medical Academy, University of Defense, 11 000 Belgrade, Serbia"},{"name":"Center for Clinical Pharmacology, Military Medical Academy, 11 000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8541-7988","authenticated-orcid":false,"given":"Menelaos","family":"Karanikolas","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Washington University School of Medicine, St Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tihomir V.","family":"Ilic","sequence":"additional","affiliation":[{"name":"Medical Faculty Military Medical Academy, University of Defense, 11 000 Belgrade, Serbia"},{"name":"Department of Neurology, Military Medical Academy, 11 000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4121-1966","authenticated-orcid":false,"given":"Dusica M.","family":"Stamenkovic","sequence":"additional","affiliation":[{"name":"Medical Faculty Military Medical Academy, University of Defense, 11 000 Belgrade, Serbia"},{"name":"Department of Anesthesiology and Intensive Care, Military Medical Academy, 11 000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.gie.2011.01.050","article-title":"Feasibility, safety, and effectiveness of transcranial direct current stimulation for decreasing post-ERCP pain: A randomized, sham-controlled, pilot study","volume":"73","author":"Borckardt","year":"2011","journal-title":"Gastrointest. 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