Patient-controlled analgesia

The most common form of patient-controlled analgesia is self-administration of oral over-the-counter or prescription painkillers. For example, if a headache does not resolve with a small dose of an oral analgesic, more may be taken. As pain is a combination of tissue damage and emotional state, being in control means reducing the emotional component of pain.

A patient-controlled analgesia infusion pump, configured for intravenous administration of morphine for postoperative analgesia

In a hospital setting, a PCA refers to an electronically controlled infusion pump that delivers an amount of intravenous analgesic when the patient presses a button.[4] PCA can be used for both acute and chronic pain patients. It is commonly used for post-operative pain management, and for end-stage cancer patients.[5]

Narcotics are the most common analgesics administered through PCAs.[6][7] It is important for caregivers to monitor patients for the first two to twenty-four hours to ensure they are using the device properly.[8]

With a PCA the patient is protected from overdose by the caregiver programming the PCA to deliver a dose at set intervals. If the patient presses the button sooner than the prescribed intake pressing the button does not operate the PCA. (The PCA can be set to emit a beep telling the patient a dose was NOT delivered). Dosage is also controlled when the patient is too sedated to press the button; preventing the patient from receiving needless doses and keeping the patient safe from overdosing.

Patient-controlled epidural analgesia (PCEA) is a related term describing the patient-controlled administration of analgesic medicine in the epidural space, by way of intermittent boluses or infusion pumps. This can be used by women in labour, terminally ill cancer patients or to manage post-operative pain.[5]

In 1968, Robert Wexler of Abbott Laboratories developed the Analgizer, a disposable inhaler that allowed the self-administration of methoxyflurane vapor in air for analgesia.[9] The Analgizer consisted of a polyethylene cylinder 5 inches long and 1 inch in diameter with a 1 inch long mouthpiece. The device contained a rolled wick of polypropylene felt which held 15 milliliters of methoxyflurane. Because of the simplicity of the Analgizer and the pharmacological characteristics of methoxyflurane, it was easy for patients to self-administer the drug and rapidly achieve a level of conscious analgesia which could be maintained and adjusted as necessary over a period of time lasting from a few minutes to several hours. The 15 milliliter supply of methoxyflurane would typically last for two to three hours, during which time the user would often be partly amnesic to the sense of pain; the device could be refilled if necessary.[10] The Analgizer was found to be safe, effective, and simple to administer in obstetric patients during childbirth, as well as for patients with bone fractures and joint dislocations,[10] and for dressing changes on burn patients.[11] When used for labor analgesia, the Analgizer allows labor to progress normally and with no apparent adverse effect on Apgar scores.[10] All vital signs remain normal in obstetric patients, newborns, and injured patients.[10] The Analgizer was widely utilized for analgesia and sedation until the early 1970s, in a manner that foreshadowed the patient-controlled analgesia infusion pumps of today.[12][13][14][15] The Analgizer inhaler was withdrawn in 1974, but use of methoxyflurane as a sedative and analgesic continues in Australia and New Zealand in the form of the Penthrox inhaler.[16][17][18][19][20][21]

Patient Controlled Intranasal Analgesia (PCINA or Nasal PCA) refers to PCA devices in a Nasal spray form with inbuilt features to control the number of sprays that can be delivered in a fixed time period.[22]

Transcutaneous delivery systems, including iontophoretic systems, are available. These are popular for administration of opioids such as fentanyl, or local anesthetics such as lidocaine. Iontocaine is one example of such a system.