Patient-controlled analgesia (PCA), well accepted and widely used to quickly ease post-operative and acute pain, is safe and effective—in skilled hands. But there are complications, caveats, and safety concerns hospitalists should consider to incorporate this tool into their pain management routines and hospital protocols.
Studies show patients prefer the PCA compared with other analgesic routes.1-2 Less clear is whether it is more effective or leads to lower opioid use.
Some hospitalists use the PCA for their patients with pain—others defer to anesthesiologists, pain services, or palliative care consultants to manage the PCA and its multifaceted dosing requirements.
“There are a lot of misconceptions about the PCA,” says Deb Gordon, RN, MS, FAAN, senior clinical nurse specialist and pain consultant at the University of Wisconsin (UW) Medical Center in Madison. “There is a misunderstanding that the PCA is a magic black box for pain relief,” which can lead to its overuse. As a general rule of pain management, patients prefer the oral route of analgesic administration, Gordon says, unless that is a problem or rapid titration is needed.
“I don’t think [the PCA is] rocket science—it’s just a tool to deliver analgesics conveniently,” Gordon says. “I think every hospitalist should learn how to use the PCA, but there are always nuances of how to titrate opioids by any route.” UW has implemented PCA protocols, which staff can use for ballpark dosing recommendations.
How Hospitalists Use the PCA
The PCA delivers pain medication intravenously via a computerized pump with a button the patient can press when needed—without waiting for busy nurses to answer a call button and then confirm, prepare, and administer an analgesic treatment.