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 situations, PCA may be a better way of providing pain relief than calling for someone (typically a nurse) to give you pain medicine. With PCA you don't need to wait for a nurse. And you can get smaller doses of pain medicine more often.
With this type of pain treatment, a needle attached to an IV (intravenous) line is placed into 1 of your veins. A computerized pump attached to the IV lets you release pain medicine 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 the PCA and can follow instructions. But people who are confused, disoriented, or unresponsive can’t use PCA.
How PCA works
Your healthcare provider must prescribe a PCA pump for you. The pain reliever 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. He or she will also figure out how much medicine 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, all to keep you from getting an overdose. A low dose of pain medicine may also be injected continuously to establish 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.
Safety monitoring during PCA use
Frequent monitoring by your nurse is needed while you are using the PCA pump. The nurse may need to wake you up in order 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 safe and effective. The main risk is having a reaction to the opioid medicine. Side effects from opioids include:
Nausea or vomiting
Low blood pressure
Trouble breathing (called respiratory depression) is the biggest danger
You should be watched carefully for respiratory depression if you:
Are an older adult
Have asthma or other lung problems
Have sleep apnea
Are not used to opioids
Need high doses of opioids for pain relief
If used properly, PCA may actually 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 oversedated 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.
March 22, 2017
Center for Clinical Standards and Quality/Survey & Certification Group. CMS., Management of Postoperative Pain. UpToDate, Patient-Controlled Analgesia: Making It Safer for Patients. Institute for Safe Medication Practices.
Turley, Ray, BSN, MSN