1 Patient-Controlled Analgesia

Question 1

Which dose is a single large dose given initially to establish analgesia?

It brings the analgesia to the therapeutic window.

Answer 1

Loading dose

Question 2

Which dose is the amount of drug that is self administered by the patient each time they activate the PCA?

Answer 2

Demand dose

Question 3

What is a lock out interval?

Answer 3

The minimum amount of time allowed between each demand dose.

Question 4

What is the typical lockout interval for PCAs?

Answer 4

1 hour or 4 hours

Question 5

What is the background infusion rate?

Answer 5

A small amount of the drug is infused continuously to maintain a low, background level of analgesia

Question 6

What is the difference between successful demand and total demand?

Answer 6

• Successful demand = pt activates the PCA system and receives a demand dose
(PUSHED IT AND GOT IT)

• Total demand = demand made
during lockout interval, and added to
above
(PUSHED IT/LOCKOUT INTERVAL and how many times they didn’t get it)

Question 7

What are the opioid analgesics used during PCA?

Answer 7

• Morphine (most common)
• Tramadol
• Fentanyl (cancer)

Tramadol and fentanyl are commonly used for break through pains

Question 8

What is the most common way to administer PCA?

Answer 8

Intravenous

Question 9

How long is a PCIA TYPICALLY used for?

Answer 9

Patient controlled intravenous analgesia is usually for a short duration

Until acute pain goes away

Usually 48 hours post op with a pump

Question 10

True or false: PCIAs for long term treatment of pain are inserted into peripheral veins

Answer 10

False: they’re implanted surgically in a large central vein.

Question 11

True or False: PCIAs can be used for long term and short term pain.

Answer 11

True: they can be used for up to 48 hours peripherally post op

Or implanted centrally to treat chronic pain

Question 12

What is a PCEA?

Answer 12

Patient controlled epidural analgesia

Question 13

Where is a PCEA administered?

Answer 13

Directly into epidural space at a specific level of the spinal cord

Question 14

Patient controlled epidural analgesias

Answer 14

• Drug administered directly into the epidural space at a specific level of the spinal cord
• Short term use
• Need smaller amount of drug
• More effective analgesia

Question 15

True or false: all PCAs breaking through the skin to be administered

Answer 15

False: Transdermal PCA

Question 16

Transdermal PCA

Answer 16

• Small patch adhered to the patients skin
• Drug – opioid (fentanyl)

-Pt self administer small dose
by pushing button

-Non invasive

Question 17

What is the drug of choice for a Transdermal PCA?

Answer 17

Fentanyl/ Opioid

Question 18

What are the pharmacological side effects of using an opioid for PCA?

Answer 18

Sedation  
Itchy skin  
Nausea  
Vomiting  
Respiration depression