Patient-Controlled Analgesia Pumps

Patient-controlled analgesia (PCA) is a type of pain management that lets you decide when you will get a dose of pain medicine. In some cases, PCA may be a better choice to ease pain than calling the nurse to give you pain medicine. With PCA you don't need to wait for a nurse. You can get smaller doses of pain medicine more often.

With this type of pain treatment, medicine is given through an IV (intravenous) line placed into your vein. A computerized pump attached to the IV lets you release pain medicine in prescribed intervals by pressing a handheld button.

PCA can be used in the hospital to ease pain after surgery. Or it can be used for painful conditions like pancreatitis or sickle cell disease. It also works well for people who can’t take medicines by mouth. PCA can also be used at home by people who are in hospice or who have moderate to severe pain caused by cancer. Children as young as age 7 can benefit from PCA if they understand the idea behind it, can follow instructions, and are closely monitored. PCA is not advised for people who are confused, disoriented, or unresponsive.

How PCA works

Your healthcare provider must prescribe a PCA pump for you. The pain medicine given through the pump will most likely be an opioid such as morphine or hydromorphone.

This is what you may expect if a PCA is prescribed for you:

• Your healthcare provider will decide on a starting dose of the pain medicine. They will also determine the dosages you will get each time you press the button, how much time there should be between doses, and the total amount of medicine you will get over a certain period of time. This is to keep you from getting an overdose. A low dose of pain medicine may also be injected continuously for a base level of pain control. All these specifics will be programmed into the pump, and the pump will record all the times you press the button and how much pain reliever you are given.

• A nurse will make sure you understand how to use the PCA machine.

• Between doses of pain medicine, IV fluid may flow into your vein to keep it open and keep you well hydrated.

• Your vital signs and oxygen levels may be checked by monitors at your bedside.

• When your pain lessens, you may be switched to a pain medicine taken by mouth.

You'll need frequent monitoring by your nurse while you are using the PCA pump. The nurse may need to wake you up to check for breathing problems and other side effects.

Family and friends staying with you during recovery should report any concerns of breathing problems or other side effects to the nurse right away.

Risks of PCA

PCA is often safe and effective. The main risk is having a reaction to the opioid medicine. Side effects from opioids include:

• Allergic reaction

• Nausea or vomiting

• Low blood pressure

• Sleepiness

• Constipation

• Trouble urinating

• Trouble breathing (called respiratory depression), which is the biggest danger

You should be watched carefully for respiratory depression if you:

• Are an older adult

• Have asthma or other lung problems

• Are obese

• Have sleep apnea

• Haven't used opioids in the past

• Need high doses of opioids for pain relief

If used properly, PCA may reduce the risks linked to opioids because you are less likely to be overtreated or undertreated. Make sure that you are the only person who pushes the button for pain relief. If friends or family members also push the button as a way to help you, there is the danger that you might get over sedated and have trouble breathing. Also, your healthcare team should explain to everyone that you don’t have to push the button as often as allowed. You only need to press it if you need pain relief.