Abstract
Patient-controlled analgesia (PCA) is an effective method for controlling acute pain, including postoperative pain in adults and in children from five years of age, pain resulting from labor, trauma, or other medical situations, or chronic and malignant pain. The treatment consists of a mini-computer-controlled infusion pump permitting the administration of on-demand, continuous, or combined doses of analgesic (mainly opioid) variations in response to therapy, which allows pain to be significantly controlled. Intravenous (IV)-PCA minimizes individual pharmacodynamics and pharmacokinetic differences and is widely accepted as a reference method for mild or severe postoperative pain. IV-PCA is the most studied route of PCA; other delivery methods have been extensively reported in the literature. In addition, IV-PCA usually voids the gap between pain sensation and analgesic administration, permitting better recovery and fewer side effects. The most commonly observed complications are nausea and vomiting, pruritus, respiratory depression, sedation, confusion and urinary retention. However, human factors such as pharmacy preparation and device programming can also be involved in the occurrence of these complications, while device failure is much less of an issue.
Highlights
Analgesia for Acute PostoperativePatient-controlled analgesia (PCA) has been used since the early 1970s to relieve multiple categories of pain, including acute, such as postoperative or labor pain, or chronic, such as palliative care or cancer pain [1,2]
This paper update is a narrative review of only opioid IV-PCA for clinicians involved in the management of acute postoperative pain
Explaining the PCA pump system to patients is generally performed before surgery at the anesthetic consultation; re-instruction after surgery is reported to be effective for optimizing PCA to increase the quality of analgesia
Summary
Patient-controlled analgesia (PCA) has been used since the early 1970s to relieve multiple categories of pain, including acute, such as postoperative or labor pain, or chronic, such as palliative care or cancer pain [1,2]. The new definition of pain is the following: An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Acute pain is a type of pain that lasts less than 3 months and is generally related to soft tissue injury or damage, such as cuts. It gradually resolves as the injured tissues heal. Alternative routes of administration include oral, transdermal, inhaled and intranasal, each with its own potential benefits or risks [3]
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