Patient-controlled analgesia (PCA) is a pain management therapy commonly used in hospitals. PCA pumps are often used after surgery because they provide a more consistent method of pain control than periodic injections of pain medication. Similar to an intravenous (IV) pump, a PCA pump allows patients to self-administer small doses of narcotics directly into the vein with a simple push of a button. A PCA pump lets patients have some control in management of their pain, within limitations as prescribed by their physician.

How does a PCA pump work?
Following surgery, patients are usually connected to a PCA pump (picture below) while still in the Recovery Room. Although the PCA pump is separate from the IV pump, the tubing from it is connected to the main IV. When the button on the patient handset is pressed, the PCA pump releases the medication into the IV line.

One type of PCA Pump

What are the advantages of using a PCA pump?
The best way to control pain and reduce physiological stress is to maintain a consistent blood level of the prescribed analgesic. In other words, you want to avoid hills and valleys in circulating blood levels of the drug. This can be accomplished by taking pain medication at regular intervals and before the pain becomes severe. Waiting until the pain is severe causes physiological distress, which can slow down the healing process and lower the ability of the medication to alleviate the pain. Patients using PCA are encouraged to medicate themselves when they start to feel uncomfortable and prior to activities such as dressing changes or physical therapy.

Another bonus to using PCA is that it can reduce—or entirely eliminate—the need for intramuscular injections. Patients receive analgesia when they need it. Because the medication enters directly into the bloodstream, pain relief is generally obtained faster than it would be with an injection.

Perhaps the biggest advantage of PCA is that it allows patients to manage their pain and become active participants in their recovery.

How safe is PCA?
The PCA pump will only release the prescribed amount of medication at programmed intervals. For example, if the pump is set to release one milligram of morphine every hour, that is the amount the pump will release, no matter how many times the button is pressed within that timeframe. PCA pain pumps can be programmed to deliver medication continuously or set to deliver pain medicine only when the patient pushes the button. Morphine and fentanyl are among the most commonly prescribed opioids (narcotics) used for patient-controlled analgesia.

Is there a risk for receiving too much medication?
The pump has a built-in computer that is programmed to administer a safe amount of medication over a specific amount of time. In addition, the pump is locked and can only be opened by the nurse or physician. PCA pumps require a special key to unlock them or change the settings. There are safeguard mechanisms that will sound an alarm if the settings are incorrect or if the pump malfunctions. In the hospital setting, patients using PCA are observed closely for excessive somnolence, changes in mental status and the like. Should the patient appear overly medicated, the dosing regimen can be changed.

Does PCA increase the potential for addiction to narcotics?
No. PCA is a pain management system generally prescribed for short-term use i.e., an average of 10 days. The likelihood of becoming addicted is minimal.

Is PCA just for surgery patients?
While PCA is frequently prescribed for postoperative patients, it is also beneficial for patients suffering from:

• Trauma
• Cancer
• Sickle Cell Crisis
• Burns

Simply put, any patient who requires opioid analgesia and who has difficulty taking medications by mouth or who is considered inappropriate for frequent injections may be a good candidate for PCA. Patients who are confused, critically ill, lacking manual dexterity or under the age of 5 are not considered good candidates.

PCA promotes a positive perception of recovery
The effectiveness of treatment relies on patient understanding of the principle behind PCA and compliance with prescribed regimen. PCA has been shown to be very useful because it is a treatment that can be customized to individual need. It offers patients an element of control over their pain, reduces anxiety and promotes healing, which in turn, can lead to a shorter hospital stay and faster recovery.