Patient-controlled analgesia
Patient-controlled analgesia | |
---|---|
analgesia | |
MeSH | D016058 |
Patient-controlled analgesia (PCA[1]) is any method of allowing a person in pain to administer their own pain relief.[2] The infusion is programmable by the prescriber. If it is programmed and functioning as intended, the machine is unlikely to deliver an overdose of medication.[3] Providers must always observe the first administration of any PCA medication which has not already been administered by the provider to respond to allergic reactions.
Routes of administration
Oral
The most common form of patient-controlled analgesia is self-administration of oral
Intravenous
In a hospital setting, an
Narcotics are the most common analgesics administered through IV PCAs.[6][7] It is important for caregivers to monitor patients for the first two to twenty-four hours to ensure they are using the device properly.[8]
With an IV PCA the patient is protected from overdose by the caregiver programming the PCA to deliver a dose at frequent set intervals. If the patient presses the button sooner than the prescribed intake pressing the button does not operate the PCA. (The PCA can be set to emit a beep telling the patient a dose was NOT delivered). The inability of an obtunded patient to push the button is also considered an inherent safety feature of PCA.[9]
Epidural
Patient-controlled epidural analgesia (PCEA) is a related term describing the patient-controlled administration of analgesic medicine in the epidural space, by way of intermittent boluses or infusion pumps. This can be used by women in labour, terminally ill cancer patients or to manage post-operative pain.[5]
Inhaled
In 1968, Robert Wexler of
Nasal
Patient Controlled Intranasal Analgesia (PCINA or Nasal PCA) refers to PCA devices in a Nasal spray form with inbuilt features to control the number of sprays that can be delivered in a fixed time period.[21]
Transdermal
Transdermal PCA using iontophoretic technology are also available. The most advanced ones are used for administration of opioids such as fentanyl. An adhesive is applied to the intact hairless skin, while a small electric current allows the ionized drug to cross the stratum corneum to deliver the analgesic dose upon the device being triggered by the patient.[9]
Advantages and disadvantages
Advantages of patient-controlled analgesia include self-delivery of pain medication, faster alleviation of pain because the patient can address pain with medication, and dosage monitoring by medical staff (dosage can be increased or decreased depending on need). With a PCA the patient spends less time in pain and as a corollary to this, patients tend to use less medication than in cases in which medication is given according to a set schedule or on a timer.[5]
Disadvantages include the possibility that a patient will use the pain medication non-medically, self-administering the narcotic for its euphoric properties even though the patient's pain is sufficiently controlled. If a PCA device is not programmed properly for the patient this can result in an under-dose or overdose in a medicine.[22] The system may also be inappropriate for certain individuals, for example patients with learning difficulties or confusion. Also, patients with poor manual dexterity may be unable to press the buttons as would those who are critically ill. PCA may not be appropriate for younger patients.
History
The PCA pump was developed and introduced by Philip H. Sechzer in the late 1960s and described in 1971.[23]
References
- S2CID 205331535.
- ISBN 978-0-8160-6063-4.
- ^ Patient controlled analgesia for adults. Thomson Healthcare, Inc. 2010.
- ISBN 978-0-8160-6412-0.
- ^ ISBN 978-0-911910-18-6.
- ISBN 978-0-683-30462-6.
- ISBN 978-0-8151-4800-5.
- ISBN 978-0-8036-1559-5.
- ^ ISBN 978-0-07-184881-7.
- ^ S2CID 1619160.
- ^ Wexler RE (1968). "Analgizer: Inhaler for supervised self-administration of inhalation anesthesia". Abbott Park, Illinois: Abbott Laboratories. Retrieved 2010-11-21.
- S2CID 30105092.
- ^ PMID 5512851.
- PMID 4903969.
- PMID 5926260.
- PMID 5233333.
- PMID 5044082.
- PMID 4534883.
- S2CID 40158248.
- National Prescribing Service (2010). "Methoxyflurane (Penthrox) for analgesia (doctor's bag listing)" (PDF). NPS RADAR. Canberra, Australia: National Prescribing Service, Department of Health and Ageing. Retrieved 2010-11-21.[permanent dead link]
- PMID 16102706.
- ^ "Patient-controlled analgesia system (PCA)". Clinical Reference Systems. Vol. 10. McKesson Health Solutions. 2010.
- ^ Pearce J (2004-10-04). "Philip H. Sechzer, 90, Expert On Pain and How to Ease It". The New York Times. Retrieved 2010-11-22.
Further reading
- Crombie JM (1876). "On the self-administration of chloroform". ISSN 0032-6518. Retrieved 2010-11-23.
- Kleiman RL, Lipman AG, Hare BD, MacDonald SD (1988). "A comparison of morphine administered by patient-controlled analgesia and regularly scheduled intramuscular injection in severe, postoperative pain". Journal of Pain and Symptom Management. 3 (1): 15–22. PMID 3351344.
- Sechzer PH (1971). "Studies in pain with the analgesic-demand system". Anesthesia and Analgesia. 50 (1): 1–10. S2CID 39886476.
- "Fast Fact and Concept #085: Epidural Analgesia". End of Life/Palliative Education Resource Center. Medical College of Wisconsin. Archived from the original on 2006-09-01.
- White PF (January 1988). "Use of patient-controlled analgesia for management of acute pain". JAMA. 259 (2): 243–7. PMID 3275811.