1. PATIENT CONTROLLED ANALGESIA Mark Broom and Gareth Parsons Chapter 29

2. Introduction This chapter examines the concept of patient controlled analgesia (PCA). You should use it in conjunction with the printed chapter to refresh your understanding of PCA, and facilitate discussion in your SCL groups. Part 1 – When and Why to Use PCA Part 2 – Using and Managing PCA

3. PART 1: When and Why to Use PCA

4. Advantages of Using P.C.A When someone is in pain, they need a method of managing the pain that is: Easy to use Safe Flexible Fast

5. Q. In what occasions may PCA be appropriate? Discuss your answers in your SCL group before continuing

6. Rationale for PCA PCA is suitable for: The management of acute postoperative pain The management of pain in those patients who are unable to tolerate oral medication Those that require frequent intramuscular or intravenous injections of opioids

7. When Not to Use PCA PCA is unsuitable for patients who: Have a severe respiratory problem or suffer from obstructive sleep apnoea Are reluctant to use the device Feel threatened by personal responsibility for pain control and would prefer some other method Are likely to experience prolonged and/or debilitating severe pain Are nursed in high dependency areas with high nurse to patient ratios. As more intensive methods may be more appropriate

8. PART 2: Using and Managing PCA

9. Types of PCA Devices There are three main types of PCA: Programmable patient controlled analgesic device Disposable PCA devices Other PCA methods

10. Basic Principles of PCA Patient Selection On demand analgesia Titration Lockout periods Dose limits Consider co-analgesics, for example Paracetamol or NSAIDS

11. Identifying and Managing Potential Complications Respiratory depression Excessive sedation Nausea and vomiting Confusion and hallucinations Pruritis Hypotension Constipation

12. Nursing Management of PCA Observation of pulse Observation of respiratory rate Observation and documentation of the volume delivered Pain assessment Sedation scores Documentation of incidents of nausea and vomiting

13. Discontinuing PCA Only discontinue a PCA when you are confident that the patients pain will be adequately managed by any alternative.