Patient-Controlled Analgesia (PCA)

Question 1

What is PCA?

Answer 1

Analgesic medication administered intravenously (IV) or into the spine by a pump - Allows the patient to have control & self administer small doses of pain medication at frequent intervals

Question 2

When are PCAs used?

Answer 2

S/p surgery, cancer treatment, chronic pain

Question 3

What do PCAs do to a drugs therapeutic effect?

Answer 3

Maintain constant therapeutic window without side effects since the level of drug does not rise above therapeutic window.

Question 4

What is a loading dose?

Answer 4

Initial large dose of a drug given to bring level of analgesia to the therapeutic window

Question 5

What is a demand dose?

Answer 5

Amount of drug that can be self administered by the patient each time they activate the PCA

Question 6

What is a lockout interval?

Answer 6

Minimum amount of time allowed between each demand dose. Patient can only click the administer button so many times within a given period of time.

Question 7

What is background infusion rate?

Answer 7

Small amount of analgesic that can be continuously administered in order to produce a low background level of analgesia.
Can increase risk of side effects, but not routinely used

Question 8

Successful vs. Total Demands

Answer 8

Total demands are all of the times the patient demanded the medication (pushed the button) whereas successful demands are the times that the drug was allowed to be released. When done appropriately there shouldn’t be much of a difference.

Question 9

Types of Analgesia in PCAs

Answer 9

Opioids or Local Anesthetics (epidural)

Question 10

PCA Pumps & Routes

Answer 10

Pumps can be external or implantable
Routes include IV, epidural or regional

Question 11

What is IV PCA?

Answer 11

Most common way to use PCA. Small intermittent doses administered through a catheter, directly into systemic circulation.
Effective for a short period of time (few days s/p surgery)

If needed longer, central venous access point is preferred

Question 12

What is epidural PCA?

Answer 12

Administered directly into area outside of meninges or into the subarachnoid space. Epidural is the preferred method due to its increased safety and less risk of damaging meninges
Epidural is more effective at pain control than IV PCA

Question 13

What is regional PCA?

Answer 13

Drug administered directly into a peripheral joint, nerve or wound to provide localized pain relief without side effects

Question 14

What is oral PCA?

Answer 14

Bedside device that provides a pill when activated by the patient

Question 15

Adverse Effects of PCA treatment

Answer 15

Same as regular opioid administration:
Sedation, GI problems, respiratory depression

Question 16

Rehab Implications for PCA

Answer 16

More alert & mobile due to decreased pain
No need to schedule therapy session at specific times because it will be regularly administered (as needed)
Monitor for signs of PCA malfunction
Signs of respiratory depression/sedation could indicate PCA overdose