5.4 Patient control analgesia
Patient control analgesia (PCA) is the standard technique for the management of moderate
or severe postoperative pain. The concept of intravenous PCA is described as a technique
that allows patients to self-administer intravenous opioids as required and dates back to the
mid-1960s. Nowadays the drugs used in this kind of devices vary according to hospital
facilities and clinician preferences. Opioids are the first line drugs used in PCA, however in
many hospitals a combination of opioids and NSAIDs for background infusions with a extra
shot at patient request are now used. Regular paracetamol and NSAIDs can be used
simultaneously. Supplementary oxygen should be considered, particularly on the first and
second postoperative nights.
Over the years, further improvements were made to the design of PCA devices. These
have resulted in increases in security and data output capacity, introduction of error
reduction programs, and a choice of mains in battery power. In addition, a variety of
disposable delivery systems are now available. Before PCA can be used safely and
effectively it is mandatory to educate the patients, all medical and nursing staff involved
in its utilization.