Acute Postoperative Pain: Patient-Controlled Analgesia

Abstract

Patient-controlled analgesia (PCA) is a technique that gives patients the ability to self-administer their pain medication as needed. PCA management is most commonly used to treat post-surgical or cancer-related pain. Intravenous opioid PCA devices are easy to initiate, but pain medications can also be delivered via epidural or peripheral nerve catheter. PCA dosing regimens include either demand dosing alone or demand dosing plus a continuous infusion. Hourly medication limits and time lockout intervals are programmed in order to minimize adverse effects. Continuous infusions should be used sparingly, especially in opioid naive patients, and increased monitoring is necessary for early detection of opioid-induced respiratory depression. When appropriate, PCA should be combined with multimodal analgesic regimens or regional anesthesia in order to reduce opioid requirement.