3.3.3.8 Patient-Controlled Analgesia (PCA)

PCA allows patients to control the amount of analgesia they receive (Ferrante, Ostheimer, and Covino, 1990). PCA can be accomplished by mouth or by the use of a special pump set to prescribed parameters to administer the drug intravenously, subcutaneously, or epidurally. In contrast to the use of PCA in postoperative pain management, the majority of the opioid dose is usually delivered via continuous systemic infusion. Patient-administered boluses are required to treat breakthrough pain and to provide a basis for more accurate and rapid upward titration of the continuous infusion rate.

Intravenous or subcutaneous PCA allows patients to accommodate transient changes in analgesic requirements (such as during dressing changes or positioning) and to tailor analgesic doses according to their own requirements. PCA is also useful in controlling pain quickly in the patient admitted to the hospital specifically for analgesia and in determining the opioid dosage requirements for conversion to an oral regimen once a steady level of satisfactory analgesia is attained (Baumann, Batenhorst, Graves, et al., 1986). Intravenous and subcutaneous PCA is safe for both home and hospitalized patients (Baumann, Batenhorst, Graves, et al., 1986; Citron, Johnston-Early, Boyer, et al., 1986; Kerr, Sone, Deangelis, et al., 1988; Swanson, Smith, Bulich, et al., 1989) but is contraindicated for sedated and confused patients (Ferrell, Cronin Nash, and Warfield, 1992).

Related Chunks

Administration Methods

Oral

Rectal

Transdermal

Nasal

Intraventricular

Adjuvant Drugs

Hydroxyzine

Index