Patient-controlled analgesia

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Patient-controlled analgesia Classification and external resources

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Patient-controlled analgesia (PCA) is any method of allowing a person in pain to administer their own pain relief.

Etymology

PCA was introduced by Dr. Philip H. Sechzer in the later 1960s and described in 1971.

General use

The most common form of this is the paracetamol that many keep in their bathroom cabinet. If a complaint, e.g. a headache, does not resolve with a small dose of painkiller then more may be taken up to a maximum dose. This situation has the patient in control, and is in fact the most common patient-controlled analgesia. As pain is a combination of tissue damage and emotional state, being in control means reducing the emotional component of pain.

Hospital use

PCA has passed into medical jargon to mean the electronically controlled infusion pump that delivers a prescribed amount of intravenous or epidural analgesic to the patient when he or she activates a button.

Opioids are the medication most often administered through PCAs.

Benefits

Among the benefits of this device are:

• It saves time between when the patient feels pain and/or the need to receive analgesia and when it is administered (activation automatically pumps the dose into a pre- existing IV line into the patient).
• It reduces workload of the nursing staff (an amount of the prescribed analgesic is pre-loaded into the PCA, enough for multiple doses).
• It reduces the chances for medication errors (the PCA is programmed per the physician's order for amount and interval between doses and "locks out" the patient if he or she attempts to self- administer too often.)
• Patients can receive medicine when they need it, instead of having to wait for nursing staff, and tend to use less.
• Patients who use PCAs report better analgesia and lower pain scores than those patients who have to request analgesia from the nursing staff when they are in pain.
• PCA provides a measurement of how much pain an individual patient is experiencing from one day to the next.
• It involves patients in their own care, giving them control and ultimately rendering better patient outcomes

Disadvantages

Disadvantages are:

• Patients may be unwilling to use the PCA or be physically or mentally unable to. (in a lot of cases physical inability can be mitigated through use of an eye gaze, sip-puff or alternative switch access method). PCA pumps are rated among the worlds most accessible pieces of equipment since all manufacturers must have alternative switch access built into their PCA pumps. Most companies will use a TASH apporoved switch interface connection as TASH is one of the industry standards in accessibility switches.
• The pumps are often expensive and may malfunction. (Malfunctions are usually limited, and many malfunctions result from an inproperly maintained/charged battery.)
• More importantly, the dosing regimen may be set so that the patient does not receive enough analgesia (bolus doses set too small, lock-out too long). When the patient sleeps, the analgesic wears off so they wake in pain. This is sometimes countered by setting a background continuous infusion of the analgesia.

Patient-controlled epidural analgesia (PCEA)

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 is most commonly used by terminally ill cancer patients.

References

• Sechzer, PH (1971). "Studies in pain with the analgesic-demand system". Anesthesia and analgesia 50 (1): 1-10. ISSN 0003-2999. PMID 5100236.
• Fast Fact and Concept #085: Epidural Analgesia, End of Life/Palliative Education Resource Center, Medical College of Wisconsin

v • d • e WikiDoc Research Resources for Patient-controlled analgesia
Articles on Patient-controlled analgesia	Most recent articles on Patient-controlled analgesia • Most cited articles on Patient-controlled analgesia • Review articles on Patient-controlled analgesia • Articles on Patient-controlled analgesia in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Patient-controlled analgesia	Powerpoint slides on Patient-controlled analgesia • Images of Patient-controlled analgesia • Photos of Patient-controlled analgesia • Podcasts & MP3s on Patient-controlled analgesia • Videos on Patient-controlled analgesia
Evidence Based Medicine Regarding Patient-controlled analgesia	Cochrane Collaboration on Patient-controlled analgesia • Bandolier on Patient-controlled analgesia • TRIP on Patient-controlled analgesia
Cost Effectiveness of Patient-controlled analgesia	Cost Effectiveness of Patient-controlled analgesia
Clinical Trials Involving Patient-controlled analgesia	Ongoing Trials on Patient-controlled analgesia at Clinical Trials.gov • Trial results on Patient-controlled analgesia • Clinical Trials on Patient-controlled analgesia at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Patient-controlled analgesia	US National Guidelines Clearinghouse on Patient-controlled analgesia • NICE Guidance on Patient-controlled analgesia • NHS PRODIGY Guidance • FDA on Patient-controlled analgesia • CDC on Patient-controlled analgesia
Textbook Information on Patient-controlled analgesia	Books and Textbook Information on Patient-controlled analgesia
Pharmacology Resources on Patient-controlled analgesia	Dosing of Patient-controlled analgesia • Drug interactions with Patient-controlled analgesia • Side effects of Patient-controlled analgesia • Allergic reactions to Patient-controlled analgesia • Overdose information on Patient-controlled analgesia • Carcinogenicity information on Patient-controlled analgesia • Patient-controlled analgesia in pregnancy • Pharmacokinetics of Patient-controlled analgesia •
Genetics, Pharmacogenomics, and Proteinomics of Patient-controlled analgesia	Genetics of Patient-controlled analgesia • Pharmacogenomics of Patient-controlled analgesia • Proteomics of Patient-controlled analgesia
Newstories on Patient-controlled analgesia	Patient-controlled analgesia in the news • Be alerted to news on Patient-controlled analgesia • News trends on Patient-controlled analgesia
Commentary on Patient-controlled analgesia	Blogs on Patient-controlled analgesia
Patient Resources on Patient-controlled analgesia	Patient resources on Patient-controlled analgesia • Discussion groups on Patient-controlled analgesia • Patient Handouts on Patient-controlled analgesia • Directions to Hospitals Treating Patient-controlled analgesia • Risk calculators and risk factors for Patient-controlled analgesia
Healthcare Provider Resources on Patient-controlled analgesia	Symptoms of Patient-controlled analgesia • Causes & Risk Factors for Patient-controlled analgesia • Diagnostic studies for Patient-controlled analgesia • Treatment of Patient-controlled analgesia
Continuing Medical Education (CME) Programs on Patient-controlled analgesia	CME Programs on Patient-controlled analgesia
International Resources on Patient-controlled analgesia	Patient-controlled analgesia en Espanol • Patient-controlled analgesia en Francais
Business Resources on Patient-controlled analgesia	Patient-controlled analgesia in the Marketplace • Patents on Patient-controlled analgesia
Informatics Resources on Patient-controlled analgesia	List of terms related to Patient-controlled analgesia

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .