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Patient-Controlled Analgesia in the Management of Postoperative Pain

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Abstract

Patient-controlled analgesia (PCA) is a delivery system with which patients self-administer predetermined doses of analgesic medication to relieve their pain. Since its introduction in the early 1980s, the daily management of postoperative pain has been extensively optimised. The use of PCA in hospitals has been increasing because of its proven advantages over conventional intramuscular injections. These include improved pain relief, greater patient satisfaction, less sedation and fewer postoperative complications.

All PCA modes contain the following variables: initial loading dose, demand dose, lockout interval, background infusion rate and 1-hour or 4-hour limits. Morphine is the most studied and most commonly used intravenous drug for PCA. In spite of the fact that it is the ‘first choice’ for PCA, other opioids have been successfully used for this option.

The most observed adverse effects of opioid-based PCA are nausea and vomiting, pruritis, respiratory depression, sedation, confusion and urinary retention.

Although intravenous PCA is the most studied route of PCA, alternative routes have extensively been described in the literature. PCA by means of peridural catheters and peripheral nerve catheters are the most studied. Recently, transdermal PCA has been described. The use of peripheral or neuraxial nerve blocks is recommended to avoid the so called opioid tolerance observed with the intravenous administration of opioids.

Numerous studies have shown the superiority of epidural PCA to intravenous PCA. The beneficial postoperative effects of epidural analgesia are more apparent for high-risk patients or those undergoing higher risk procedures. PCA with peripheral nerve catheters results in increased postoperative analgesia and satisfaction for surgery on upper and lower extremities. Serious complications occur rarely with these catheters.

With the introduction of an Acute Pain Service, management of postoperative pain can be improved. This will also help to minimise adverse effects related to PCA and to avoid lethal mishaps.

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  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The authors express their gratitude to Dr P. Baele and Dr F. Veyckmans for their redactional help. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Anaesthesiology, University Hospital St Luc, Brussels, Belgium

    Mona Momeni, Manuela Crucitti & Marc De Kock

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  1. Mona Momeni
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  2. Manuela Crucitti
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  3. Marc De Kock
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Correspondence to Mona Momeni.

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Momeni, M., Crucitti, M. & De Kock, M. Patient-Controlled Analgesia in the Management of Postoperative Pain. Drugs 66, 2321–2337 (2006). https://doi.org/10.2165/00003495-200666180-00005

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