(PDF) Patient-controlled analgesia

PATIENT CONTROL
ANALGESIA

Table of Contents
INTRODUCTION...........................................................................................................................3
TASK...............................................................................................................................................3
Patient control analgesia in orthopaedic ward............................................................................3
Guidelines and policies for PCA.................................................................................................3
Preparation of PCA.....................................................................................................................4
Discarding PCA..........................................................................................................................4
Documentation on using PCA.....................................................................................................5
Different medication used as PCA..............................................................................................5
Indication of PCA.......................................................................................................................5
Side effect of PCA......................................................................................................................6
More information related on PCA...............................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Patient control analgesia refers to a delivery system with which sick people can self
administer predetermined doses of analgesic medications in order to relieve their pain. It includes
to make an individual capable to control their pain by making them knowledgeable (Assouline
and et. al., 2016). The present report will focus on patient control analgesia in orthopaedic ward
including appropriate guidelines as well as policies of PCA. It will also includes the description
about preparation and discarding of PCA along with proper documentation on using PCA. The
different types of medications used as PCA and indication as well as side effects of PCA is given
below.
TASK
Patient control analgesia in orthopaedic ward
Patient control analgesia can be described as a type of pain management in which a
person self decide that when they should take dose of pain relieving medicines. It has been
analysed that post operative pain management can be known as a critical task in respect of
optimal care of orthopaedic surgery patients. However, the opioids are considered as an effective
for reducing severe pain as it administer intramuscularly as epidurals or IV as patient controlled
analgesia. It has been analysed that infusion pumps can be used after total knee arthroplasty and
anterior cruciate ligament (ACL) that are considered as effective method of adjunctive therapy as
well as pre emptive analgesia. Meanwhile, it is observed that oral opioids are known as more
efficient analgesic for moderating severe pain (Fabi, 2016). At the other hand, tramadol is much
effective in comparison to morphine along with containing fewer severe side effects which is
mostly preferred to use in moderately severe pain. In context of pain management of knee, hip &
ACL procedures, the opioid sparing NSAIDS (Nonsteroidal anti-inflammatory drugs) like
ketorolac and COX-2-specific NSAIDS are prescribed by physicians accordingly.
Guidelines and policies for PCA
Patient controlled analgesia consist number of guidelines & policies which are discussed
here. Initially, All registered nurse caring for patients receiving PCA should complete and pass
their opioids competency annually (Song And et. al., 2016). Secondly, PCA can be utilise in
context of moderate to severe pain management while inadequate analgesia would results from
oral analgesia or intermittent IV morphine boluses. Thirdly, contradiction to PCA consist that if a

patient unable to understand concept of PCA & do not want to control their own analgesia then
nurse controlled opioid infusion is considered to be more favourable. However, the PCA is
known as specialised analgesia technique and managed by CPMS as only CPMS & anaesthesia
staff may prescribe PCA including safety purposes. In addition to this, opioid solution for PCA is
required to be done in appropriate manner by maintaining correct concentration of elements.
Meanwhile, PCA syringe should be prepared as per RCH medication policy and labelled clearly
with a blue intravenous additives label. Moreover, PCA delivery consist that volume infused
must be evaluated in every hour and documented on fluid balance chart. Furthermore, it involves
concurrent drugs usage, effective precautions, family members & PCA, patient review and
observations.
Preparation of PCA
The preparation of patient controlled analgesia (PCA) consist the role of clinical
professionals to make sure regarding several aspects which are given below. Initially, the patient
and their family members are required to be prepared for PCA by explaining them about it and
process of this technique to get rid off pain. However, family members are advised that they are
not allowed for administering a bolus by pressing a button for PCA in very sensitive way. In
addition to this, it is necessary to make patient understand about concept of PCA appropriately if
they are willing to press the button (Capdevila and et. al., 2017). Moreover, if patient or family
members have any kind of query, confusion or doubt then they can be immediately contact to
care practitioners for further information.
Discarding PCA
In context of discarding PCA, there are number of aspects which are required to be
considered in proper way. Firstly, it includes that one standard concentration should be
established for every opiate utilise for PCA. Secondly, the morphine and hydromorphone can be
stocked only as per standards concentrations in patient care unit and meperidine for PCA should
be dispensed from pharmacy (Barnard, 2016). Thirdly, the personnel is required to separate
stored hydromorphone from morphine by avoiding mix ups in patient care units as well as
pharmacy. However, it is essential to make a list of patient allergies before PCA orders are
entered into health records. In addition to this, it is an important aspect to set limited dosage of
PCA opiates in pharmacy records which facilitate to place an alert of a safe side is exceeding
during order entry. Meanwhile, the employees are required to affix a prominent warning to label

if in case an opiate is being dispensed in a non-standard concentration. Moreover, it is necessary
to use prefilled syringes, bags & cassettes and clinicians should remain alert to potential drug
shortages on PCA opiates.
Documentation on using PCA
The documentation is very important in health care as it is helpful to fulfil number of
future purpose and become very significant when patient is not in conscious state. It consist to
conduct documentation of PCA utilisation and pump settings by recording rates like mg/hr or
mcg/hr, actual demands of a sick person, PCA deliveries, cumulative total and additional
clinician boluses if given to the patient as per situational requirement accordingly (Gonzalez And
et. al., 2016). However, it is also essential to take several specific observations such as
respiratory rate to analyse that whether an individuals is capable to breath & cough by evaluating
their depth & ability for the same. Moreover, it consist to evaluate the side effects including
nausea, pruritus or vomiting and put efforts to provide SpO2 if required in case of particular
patient. Meanwhile, any other changes which has been done in PCA prescription so that correct
dosages will taken by sick person. Additionally, the regular pain assessment should be carried
out to determine suitability of present medications which are also recorded in documentation of
PCA.
Different medication used as PCA
In context of PCA, the mostly preferred medication is opioids including morphine which
is prescribed to sick people by care professionals for their well being. It includes utilisation of
morphine in all the cases but in several specialised cases other medications are considered to be
more favourable for making people well being (Bohl And et. al., 2016). However, it is important
to prefer another medications for specific patients due to their particular medical situations.
Meanwhile, hydromorphone can be used in PCA for such people who requires very high level of
dosage in order to get rid off severe pain. Moreover, meperidine is utilised in few of cases when
patient has problem of allergic reaction of morphine then this medications can be considered as
more favourable.
Indication of PCA
The indication of PCA includes that number of verbal orders to change does must be kept
as low as possible. However, it is necessary to write order of PCA in milligram or micro grams

rather than millilitres (Gessler and et. al., 2016). Meanwhile, it is significant for employees to
recheck allergies of patients before selecting specific opiate to be utilised for PCA. In addition to
this, morphine is known as a choice of an opiate whereas hydromorphone and meperidine can be
used in specific cases such as when an individual needs very high dose or a person having
allergic reaction with morphine. Moreover, it is important to determine loading and maintenance
doses the medical professionals must focus on another medications that patient has received or
currently taking. Furthermore, it is mandatory for clinical practitioners to analyse
appropriateness of PCA therapy is required to be reassessed at regular intervals.
Side effect of PCA
The side effects and complications of using PCA are required to be evaluated by clinical
professionals to take immediate actions for reducing its negative impacts on condition of a
patient. Basically, it impacts on overall organ system of body including respiratory system which
facilitate to develop situation of apnoea and respiratory depression (Chen And et. al., 2017).
However, PCA effects central nervous systems get disturbed which results into sedation that is
known as primary indicator for impending respiratory depression. In addition to this, it also
impacts on gastrointestinal tract which create symptoms such as nausea and vomiting as well as
it is responsible for reducing motility of gut results constipation. Meanwhile, it involves
developed genitourinary problem which foster to occurrence of condition affecting urinary
retention. Moreover, it consist the problem related to dermatology which is known as pruritus
and other issue like depression & sedation that are required to be focussed by medical
practitioners to treat them for wellness of patient.
More information related on PCA
The additional information regarding use of PCA can includes monitoring effects of PCA
which are discussed here. Firstly, it is essential to establish standards measurement scale in order
to asses level of pain of patient. Secondly, it is necessary to develop requirements for patients
receiving PCA including vital signs, level of pain, rate & quality of respirations and alertness
should be evaluated every four hours (Katz and et. al., 2017). Thirdly, it is important for care
professionals to remain always alert regarding signs of over sedation and required evaluate
response of an individuals whether it is verbal or tactile stimulation. Meanwhile, it is required to
monitored sick people during initial 24 hours in more frequent manner when hypoxia and hypo
ventilation tend to take place. However, it is significant for nursing staff to monitor critical

patients regularly in which nurse controlled analgesia should be more suitable. In addition to this,
it is must to be kept the floe sheets at the bedside in order to document the dosages of PCA as
well as monitoring of patient. Furthermore, it is mandatory for staff members to monitor the use
of naloxone in respect of determining PCA related adverse events.
CONCLUSION
From the above report, it has been concluded that patient control analgesia can be
described as a delivery system with which sick people can self administer predetermined doses
of analgesic medications in order to relieve their pain. It consist guidelines for PCA such as
contradiction to PCA, pain management, managed by CPMS, opioid solution for PCA,
concurrent drugs usage and many more. However, it involves documentation of patient receiving
PCA for recording rates in gm/hr, actual demands of a sick person, PCA deliveries, cumulative
total and additional clinician boluses. Moreover, there are several side effects of PCA which are
observed including nausea, sedation, apnoea and depression.

REFERENCES
Books and journals
Assouline, B. and et. al., 2016. Benefit and harm of adding ketamine to an opioid in a patient-
controlled analgesia device for the control of postoperative pain: systematic review and
meta-analyses of randomized controlled trials with trial sequential analyses. Pain.
157(12). pp.2854-2864.
Fabi, D.W., 2016. Multimodal analgesia in the hip fracture patient. Journal of orthopaedic
trauma. 30. pp.S6-S11.
Song, M.H. And et. al., 2016. Peri-articular injections of local anaesthesia can replace patient-
controlled analgesia after total knee arthroplasty: a randomised controlled study.
International orthopaedics. 40(2). pp.295-299.
Capdevila, X. and et. al., 2017. Effectiveness of epidural analgesia, continuous surgical site
analgesia, and patient-controlled analgesic morphine for postoperative pain
management and hyperalgesia, rehabilitation, and health-related quality of life after
open nephrectomy: a prospective, randomized, controlled study. Anesthesia &
Analgesia. 124(1). pp.336-345.
Barnard, S., atHand Medical Inc., 2016. Hand strap for patient controlled analgesia control.
U.S. Patent 9,492,615.
Katz, P. and et. al., 2017. Sublingual, transdermal and intravenous patient-controlled analgesia
for acute post-operative pain: systematic literature review and mixed treatment
comparison. Current medical research and opinion. 33(5). pp.899-910.
Gonzalez, K.W. And et. al., 2016. Epidural versus patient-controlled analgesia after pediatric
thoracotomy for malignancy: a preliminary review. European Journal of Pediatric
Surgery. 26(04). pp.340-343.
Bohl, D.D. And et. al., 2016. Multimodal versus patient-controlled analgesia after an anterior
cervical decompression and fusion. Spine. 41(12). pp.994-998.
Gessler, F. and et. al., 2016. Postoperative patient-controlled epidural analgesia in patients with
spondylodiscitis and posterior spinal fusion surgery. Journal of Neurosurgery: Spine.
24(6). pp.965-970.
Chen, M.C. And et. al., 2017. Implantable polymeric microneedles with phototriggerable
properties as a patient-controlled transdermal analgesia system. Journal of Materials
Chemistry B. 5(3). pp.496-503.