Abstract
Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to.
Highlights
Patient-controlled analgesia (PCA) was clinically introduced to adults in 1971 to quickly and effectively relieve postsurgical pain
This would allow the hospital to think critically for improvements in their establishment to minimize any future adverse events. Another clinical challenge of PCA use is the lack of consensus on the optimal PCA parameter programming in the pediatric population [10]
This must be differentiated from nurse-controlled analgesia (NCA) which is defined as PCA delivered by proxy
Summary
Patient-controlled analgesia (PCA) was clinically introduced to adults in 1971 to quickly and effectively relieve postsurgical pain. Giving patients the control over analgesic drug administration allows for better titration to maximize pain relief and minimize risk of overdose [2]. This active self-management of pain is an important factor concerning patients’ psychological well-being since the patient can receive pain medication immediately without the need for a nurse to administer it. Selection and programming of the pump, monitoring and selection of patients, staff and patient/parent education, as well as the use of PCA by proxy are recurrent themes for safe PCA use – Smart pumps with barcode scanning – Computer provider entry – Establish reporting system – Regular audits – Standardization of protocol – Patient evaluation – Risk stratification – Staff education – Assessment of sedation level – Smart pumps with oximetry and capnography
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