Patient controlled analgesia

The expected outcomes of the patient may include a relief of pain, an understanding of the use of die patient-controlled analgesia device (when applicable), an absence of injury, an adequate nutrition intake, an absence of drug dependence, and an understanding of and compliance with the prescribed treatment regimen. 

Using Fhtient-Co ntro lied Analgesia. Patient-controlled analgesia (PCA) allows patients to administer their own analgesic by means of an IV pump system (Fig. 19-1). The dose and die time interval permitted between doses is programmed into die device to prevent accidental overdosage. 

In some situations, narcotic analgesics may be ordered tor pain relief using patient-controlled analgesia (PGA). If the patient will be receiving PGA at home, the nurse makes sure to review the following steps with the patient and the caregiver ... 

Patient-controlled analgesia in noncritically ill patients o As needed, method (e.g., pm) should be avoided if patient has continuous analgesic requirements... 

BA is a 58-year-old male recently diagnosed with lung cancer. Following surgery he was placed on morphine patient-controlled analgesia (PCA). He has been using 120 mg of morphine/24 hours with adequate pain control. 

PCA Patient-controlled analgesia PVT Paroxysmal ventricular tachycardia... 

Severe pain should be treated with an IV opioid titrated to pain relief and then administered on a scheduled basis with as-needed dosing for breakthrough pain. Patient-controlled analgesia is commonly utilized. 

A study on racial differences in receipt of analgesics found that nearly three-fourths (74%) of white patients compared with 57% of African American patients received analgesics for lower extremity fractures in emergency departments (Todd et al., 2001). An assessment of racial/ethnic differences in physicians prescriptions of patient-controlled analgesia for postoperative pain found that after adjustment for age, gender, preoperative... 

Ng, B. and J. Dimsdale, "The Effect of Ethnicity on Prescriptions for Patient Controlled Analgesia for Post-Operative Pain," Pain 66(1), 9-12 (1996). 

Rapp SE, Egan KJ, Ross BK, Wild LM, Terman GW, Ching JM. (1996). A multi-dimensional comparison of morphine and hydromorphone patient-controlled analgesia. Anesth Analg. 82(5) 1043-48. 

Parenterals are administered to the body by injection. They must be sterile, nonpyro-genie, and particulate-free. Examples of compoimded parenterals include high-dose analgesics for patient controlled analgesia (morphine sulfate 50 mg/mL), antiemetic injections, fentanyl and bupivacaine injections for ambulatory pump reservoirs, oncology combinations, and others (Table 10). 

Patient-controlled analgesia (PCA) is an alternative method of administration of morphine. The use of an indwelling catheter allows the patient to administer the drug at frequent intervals for pain relief. PCA systems allow patients the freedom to assess the need for their own analgesia and to titrate a dose tailored to their needs. Dependence is rarely observed in patients using PCA for acute pain management. 

Patient-controlled analgesia (PCA) IV Loading dose 50-100 mg. Intermittent bolus 5-30 mg. Lockout interval 10-20 min. Continuous infusion 5 0mg/hr. Maximum (4-hr) 200-300 mg. 

Varrassi G, et al. A double-blinded evaluation of propacetamol versus ketorolac in combination with patient-controlled analgesia morphine analgesic efficacy and tolerability after gynecologic surgery. Anesth Anaig 1999 88 611-16. 

Hill HF, Mather LE Patient-controlled analgesia. Pharmacokinetic and therapeutic considerations. Clin Pharmacokinet 1993 24 124. [PMID 8453822]... 

Dosages and routes of administration Morphine is available in different salt forms but the hydrochloride and sulfate (Vermeire and Remon, 1999) are used preferentially. The compound can be administered by the oral, parenteral or intraspinal route. Oral application is preferred for chronic pain treatment and various slow release forms have been developed to reduce the administration frequency to 2-3 times per day (Bourke et al., 2000). Parenteral morphine is used in intravenous or intramuscular doses of 10 mg, mostly for postoperative pain and self-administration devices are available for patient-controlled analgesia (PCA). Morphine is additionally used for intraspinal (epidural or intrathecal) administration. Morphine is absorbed reasonably well in the lower gastrointestinal tract and can be given as suppositories. 

Dosages and routes of administration Oxymorphone is used parenterally by intramuscular or subcutaneous doses of 1-1.5 mg and as suppositories with a content of 5 mg. For patient controlled analgesia (PCA) i.v. bolus doses up to 300 pg are used (Sinatra and Harrison, 1989). 

Lehmann, K.A., Tenbuhs, B., Hoeckle, W. Patient-controlled analgesia with piritramid for the treatment of postoperative pain, Acta Anaesthesiol. Belg. 1986, 37, 247-257. 

Sinatra, R.S. and Harrison, D.M. Oxymorphone in patient-controlled analgesia, Clin. Pharm. 1989, 8, 541-544. 

Medico-technical instruments such as infusion pumps can be used in PCA (patient-controlled analgesia, Fig. 1) to provide patient-orientated and therapy as required, e.g. with morphine injection solutions. Depending on the patients perception of pain, they may add small doses of analgesics to the basic infusion by means of an electrically controlled infusion pump. The physician specifies the basic dose, which is infused independent of patient demands, the boluses that can be demanded, an hourly maximum dose and a refractory time that cannot be reduced between two doses. The infusion may be given intravenously, subcutaneously, epidurally or intraspinally. 

Colwell CW, Jr. The use of the pain pump and patient-controlled analgesia in joint reconstruction. 

Alon E, Jaquenod M, Schaeppi B. Post-operative epidural versus intravenous patient-controlled analgesia. Minerva Anestesiol. 2003 69 443—4-46. 

Aygun S, Kocoglu H, Goksu S, et al. Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine + fentanyl combination. EurJ Gynaecol Oncol. 2004 25 498-501. 

Evans E, Turley N, Robinson N, Clancy M. Randomised controlled trial of patient controlled analgesia compared with nurse delivered analgesia in an emergency department. EmergMedJ. 2005 22 25-29. 

Prakash S, Fatima T, Pawar M. Patient-controlled analgesia with fentanyl for burn dressing changes. Anesth Analg. 2004 99 552-555. 

Chen JY, Wu GJ, Mok MS, et al. Effect of adding ketorolac to intravenous morphine patient-controlled analgesia on bowel function in colorectal surgery patients—a prospective, randomized, double-blind study. Acta Anaesthesiol Scand. 2005 49 546-551. 

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