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Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety

  • Patient Safety in Anesthesia (SJ Brull, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We aim to (1) identify the benefits and risks of patient-controlled analgesia and (2) analyze the risks of using various modalities of PCA among patients with traumatic injuries, sleep apnea, chronic pain, or neuropathies.

Recent Findings

An oral sufentanil PCA system may be as effective as an intravenous PCA. The overall incidence of PCA device error is less than 1%. While IV PCA may not be more effective than nurse-administered opioid among trauma patients, thoracic epidural analgesia may improve outcomes. Patients with obstructive sleep apnea or obesity are at increased risk of opioid-induced respiratory depression (OIRD). Patients with chronic pain or opioid tolerance, who may require higher opioid dosing, benefit from close monitoring. Continuous pulse oximetry and capnography can improve detection of OIRD. Risk of nerve injury after nerve block may be higher among patients with peripheral neuropathy, but this risk may be decreased with lower local anesthetic total dose or concentration.

Summary

PCA, whether in intravenous, neuraxial, or peripheral nerve form, can have a significant role in postoperative analgesia. Regardless of technique, use of a PCA method should account for the potential risks to the patient, particularly in the presence of comorbidities such as sleep apnea, polytrauma, chronic pain, and preexisting neuropathy.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Alberto Ardon

  2. Regional Anesthesia and Acute Pain Medicine Fellow, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    Nigel Gillespie

  3. Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Sree Kolli

  4. Department of Anesthesiology, University of Virginia Health System, PO Box 800710, Charlottesville, VA, 22908, USA

    Ashley Matthews Shilling

  5. Department of Anesthesiology, University of Florida College of Medicine – Jacksonville, 2nd Floor Clinical Center, 655 West 8th St, C72, Jacksonville, FL, 32209, USA

    Matthew Warrick

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  1. Alberto Ardon
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Correspondence to Alberto Ardon.

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This article is part of the Topical Collection on Patient Safety in Anesthesia

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Ardon, A., Gillespie, N., Kolli, S. et al. Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety. Curr Anesthesiol Rep 10, 463–472 (2020). https://doi.org/10.1007/s40140-020-00406-5

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